Childhood tuberculosis in the WHO European region: a hidden epidemic

TDR news item
17 January 2014

A new study published in the Lancet Global Health has found that many children with tuberculosis (TB) in the European region of the World Health Organization (WHO) may not be getting appropriate treatment. In 2011, while 23 000 children were estimated to suffer from TB in 18 high priority countries, fewer than 1 000 cases were detected and reported. Moreover, nearly 5 000 of the TB cases were estimated to be multidrug-resistant (M/XDR-TB). This could be due to under-diagnosis or under-reporting, and further research is needed.

“Childhood TB and MDR-TB is a hidden epidemic. This study shows that despite progresses in adoption of WHO guidelines on childhood TB into national policies, there are significant gaps in implementation of measures to improve diagnosis and treatment of children with TB and M/XDR-TB.”

Dr Masoud Dara
TB and M/XDR-TB Programme Manager of WHO’s European office

Tuberculosis (TB) in children can be difficult to diagnose. The symptoms may be vague and non-specific. Young children usually cannot produce the sputum samples needed by the laboratory to diagnose the illness. Even when children with TB produce specimens, these are frequently found to be negative or contain very few TB bacteria. Thus, globally childhood TB often goes unrecognized, which is of particular concern in regions with a high burden of multidrug-resistant and extensively drug-resistant TB (M/XDR-TB).

“Childhood TB and MDR-TB is a hidden epidemic. This study shows that despite progress in adoption of WHO guidelines on childhood TB into national policies, there are significant gaps in implementation of measures to improve diagnosis and treatment of children with TB and M/XDR-TB,” says Dr Masoud Dara, TB and M/XDR-TB Programme Manager of WHO’s European office.

In response to this and to increasing rates of M/XDR-TB in that region, in 2011 the WHO Regional Office for Europe launched the Consolidated Action Plan to Prevent and Combat M/XDR-TB (2011-2015). The Plan includes a number of milestones for action targeted at childhood TB, such as the scale-up of access to treatment; prioritization of childhood TB in Member States’ national strategic TB plans; and development of a special response for diagnosing and treating TB in children.

The WHO Europe Task Force on Childhood TB was subsequently formed, which collected data on national childhood TB policies from 15 (out of 18) high-priority countries from September 2012 to January 2013. The study found that all 15 countries currently have policies that adhere to the 2006 WHO guidelines. However, it found that work still remains for updating policies for contact-tracing in children of close non-household contacts and subsequent prescription of MDR-TB treatment regimens. It was also found that clarity on policies for ambulatory care is also needed.

The study was managed by staff in the TB and MDR/XDR-TB Programme at the European regional office of WHO, who received support from TDR to participate in the SORT IT operational research and training training programme to design and implement the study. The Lancet Global Health article provides both the results and a table on case detection and treatment in 18 high-priority countries. Updated WHO guidelines on the management of childhood TB are anticipated.

For more information, contact:

Andy Ramsay (ramsaya@who.int) or Masoud Dara (daram@who.int)

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