Children and Adolescents

Children living with HIV have a high risk of rapid progression to severe disease and death if a diagnosis of TB is missed. A child living with HIV is 3.5 times more likely to progress to TB disease than a child who is HIV-negative (29). The risk, although greatly reduced, remains elevated in children on antiretroviral therapy (ART). An estimated 10% of paediatric deaths from TB are among children living with HIV, with 21 000 deaths annually (1).

Once the contacts of a person with TB have been identified, the contacts should be screened for TB symptoms and/or undergo CXR, followed by appropriate diagnostic evaluation (15, 28). Contact investigation can be expensive and time-consuming for HCWs. Additionally, TB is a highly stigmatized disease in some settings, and the visit of a health worker to a person’s home may risk discrimination against the household.

As in adults, TST and IGRA should not be used to screen for TB disease in children (26, 27), as these tests cannot distinguish TB infection from TB disease and cannot predict who will progress to TB disease. Both tests provide a marker of TB infection but may be influenced by mechanisms unrelated to TB infection and give false-negative or false-positive results. The role of these tests in decisionmaking for TPT and in the diagnostic evaluation of children with presumptive TB is discussed in

mWRDs are not currently recommended for screening for TB disease in children and young adolescents aged under 15 years, but they should be used to diagnose TB in children who screen positive using a symptom screen or CXR (see Chapter 4).

In addition to planning and budgeting, NTPs should consider the following key implementation steps in contact investigation:

Contact investigation to identify children, adolescents and other household members with TB disease and to identify those who will benefit from TPT should be a standard component of all national TB programmes. Contact investigation is good public health practice and essential to address and manage several infectious diseases such as coronavirus disease 2019 (COVID-19).

Household contacts of people with PTB are a well-recognized group at risk for TB infection and TB disease, including prevalent TB detected at the time of initial contact investigation and incident TB that occurs within the subsequent 2–5 years (15). WHO recommends that household contacts and other close contacts of people with PTB should be systematically screened for TB disease (14). Contact investigation can be implemented at the health facility, in the community or through a combination of these approaches.

This chapter includes current WHO recommendations that apply to children and adolescents on TB screening and contact investigation. They have been consolidated from current WHO guidelines on systematic screening for TB disease and contact investigation, namely the WHO consolidated guidelines on tuberculosis. Module 2: screening - systematic screening for tuberculosis disease (11) and Guidance for national tuberculosis programmes on the management of tuberculosis in children (second edition) (8).