Children and Adolescents

Unless otherwise specified, the terms defined here apply as used in this document. They may have different meanings in other contexts.

Active (tuberculosis) case-finding: Provider-initiated screening and testing in communities by mobile teams, often using mobile X-ray and rapid molecular tests. The term is sometimes used synonymously with "systematic screening".

The production and writing of the WHO consolidated guidelines on tuberculosis. Module 5: management of tuberculosis in children and adolescents, 2022 was coordinated by Sabine Verkuijl, Annemieke Brands, Kerri Viney and Tiziana Masini, under the guidance of Farai Mavhunga, head of the TB Vulnerable Populations, Communities and Comorbidities unit and the overall direction of Tereza Kasaeva, Director of the World Health Organization (WHO) Global Tuberculosis (TB) Programme.

Non-severe TB is defined as peripheral lymph node TB, intrathoracic lymph node TB without airway obstruction, uncomplicated TB pleural effusion or paucibacillary, non-cavitary disease confined to one lobe of the lungs and without a miliary pattern.

Infants aged under 3 months or weighing less than 3 kg (including premature birth (under 37 weeks) were not eligible for inclusion in the SHINE trial. No new data on treatment of congenital TB and very young infants aged 0–3 months with TB disease were received following a call for data.

As in adults, TB treatment in children and adolescents includes a 2-month intensive phase followed by a continuation phase of 2–4 months. In the intensive phase, TB bacilli are rapidly killed to prevent disease progression, transmission and development of drug resistance. In the continuation phase, dormant bacilli are eliminated to effect cure and prevent relapse.

Any child aged under 10 years who has had close contact with a person with TB disease should be screened for TB with a symptom screen or CXR as part of contact investigation. Symptoms used to screen for TB are cough for more than 2 weeks, fever for more than 2 weeks, and poor weight gain or weight loss in the past 3 months. In young children, reduced playfulness or lethargy should also be included, since prolonged cough may be absent in children with disseminated disease.

Screening serves to identify children and adolescents who may have TB disease (presumptive TB) and who need further evaluation to make or confirm a TB diagnosis (see Chapter 4). It also helps to identify children and adolescents who are eligible for and could benefit from TPT. A screening test is not intended to be a diagnostic tool. People with positive results on a screening test should undergo further diagnostic evaluation.

By reducing cell-mediated immunity, undernutrition increases the risk of TB, while the catabolic effect of TB disease results in weight loss and wasting, creating a vicious cycle (105, 228). Globally, about 45% of deaths in children aged under 5 years are attributable to undernutrition (228). Undernutrition may be acute or chronic and categorized as moderate or severe.