Children and Adolescents

It is important to exclude TB disease before initiating TPT. A clinical algorithm based on screening for symptoms of TB, history of contact with a person with TB, HIV status, age, TB infection test results and abnormal findings on CXR is recommended (15). Figure 3.4 shows an algorithm applicable to children aged under 5 years with and without HIV, and children and adolescents aged 5 years and over.

The WHO consolidated guidelines on tuberculosis (28) and the WHO operational handbook on tuberculosis (15) identify two broad at-risk child and adolescent populations that need systematic assessment for eligibility for TPT:

BCG vaccine is used extensively worldwide, with about 100 million newborns vaccinated each year. Severe adverse events are reported only occasionally. For some adverse events (e.g. disseminated BCG disease), the diagnosis may depend on the culturing of M. bovis BCG to distinguish it from other forms of mycobacterial disease (33). It is important to recognize that M.

Training of health care providers to administer BCG vaccination is important to ensure the correct technique is used. The standard dose of BCG vaccine is an intradermal injection of 0.05 mL of the reconstituted vaccine for infants aged under 1 year, and 0.1 mL for infants aged over 1 year. BCG vaccine can safely be given together with other routine childhood vaccines, including the hepatitis B birth dose. Although efforts should be made to use all doses in BCG multidose vials, children should be vaccinated even if this means part of the vial is wasted.

BCG in children living with HIV

BCG is a live attenuated bacterial vaccine derived from Mycobacterium bovis that was originally isolated in 1902 from a tuberculous cow. BCG has demonstrated significant effectiveness, but protection has not been consistent against all forms of TB in all age groups. BCG has also shown effectiveness in preventing leprosy (caused by Mycobacterium leprae) and Buruli ulcer (caused by Mycobacterium ulcerans) (31).

This chapter describes strategies for the prevention of TB in children and adolescents. It covers BCG vaccination, TPT and TB infection prevention and control. This chapter relates to the section of the pathway highlighted in blue in Figure 3.1.

Figure 3.1. Pathway through exposure, infection and disease covered in Chapter 3

Figure 2.8. Algorithm for TB screening of children living with HIV with symptoms

This annex provides information on administering, reading and interpreting tuberculin skin tests (TSTs).

A TST is the intradermal injection of a combination of mycobacterial antigens that elicit a delayed-type hypersensitivity immune response, represented by induration, which can be measured in millimetres.

TB disease should be excluded in neonates born to women with presumptive or confirmed TB. The level of infectiousness and drug susceptibility in the mother should be determined. It is not necessary to separate the neonate from the mother. Breastfeeding should be continued and the mother advised to wear a surgical mask when close to the baby (191).