TB KaSPar
Feedback
About a quarter of the world’s population has been infected with Mycobacterium tuberculosis. The vast majority of these people do not have TB disease (10). It is estimated that 7.5 million children and young adolescents aged under 15 years are newly infected with M. tuberculosis each year (11). Cumulatively, about 67 million children and young adolescents aged under 15 years are infected with M.
TB is a common cause or comorbidity in children with clinically diagnosed pneumonia. A systematic review on TB in acute respiratory infection found that M. tuberculosis was identified in around 5–10% of children with pneumonia aged under 5 years in TB endemic countries (223). Limited data from clinical and autopsy studies suggest that TB was also associated with mortality in these children. Prevalence studies, including the multisite PERCH study (224), confirm these findings.
In 2014, World Health Assembly Resolution WHA67.19 called upon WHO and Member States to improve access to palliative care as a core component of health systems, with an emphasis on PHC and community- and home-based care (197). WHO is supporting integration of palliative care into all relevant global disease control and health system plans and is promoting improved access to palliative care for children, in collaboration with the United Nations Children’s Fund.
Routine safety monitoring of treatment should generally follow the recommended approach in adults and should be guided by the known adverse effect profile of the medicines included in the regimen.
Table 5.14 summarizes the most common adverse effects of the medicines used for MDR/RR-TB.
This section covers the standardized shorter all-oral bedaquiline-containing regimen and individualized regimens for children and adolescents not eligible for the shorter all-oral bedaquiline-containing regimen. It also includes other important considerations, including treatment of EPTB and TB/HIV coinfection, and dosing and formulations.
Sensitivity for TB of “any abnormality” as reported on CXR in close contacts aged under 15 years is 84%, and specificity is 91% (25). It is thus more specific than symptom screening alone. Estimates of the accuracy of CXR are not disaggregated by age group, and significant differences in CXR findings between younger and older children may lead to important differences in sensitivity and specificity by age group.
TB contact investigation can be implemented at the health care facility or at the community level, or as a combination. This section contains some examples of approaches to contact investigation, including lessons learnt.
