TB KaSPar
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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).
Children with TBM should preferably be hospitalized for initiation of treatment and close monitoring. Children aged under 2 years with miliary TB should be evaluated for TBM regardless of the presence of CNS symptoms. If these children are not evaluated for TBM for any reason, extension of treatment to 12 months may be considered.
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.
In addition to planning and budgeting, NTPs should consider the following key implementation steps in contact investigation:
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.
WHO provides guidance on the principles29 and recommendations for nutritional care and support of people with TB as part of their regular TB care.
Five guiding principles are key for providing nutritional care and support as an integral part of TB care and prevention (105):
