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TB Notes 1, 2003

Update from the International Activity

New International Efforts in Childhood TB

On October 6-7, 2002, a “Workshop on Tuberculosis in Children” was held to assess research priorities in childhood TB in conjunction with the International Union Against TB and Lung Disease (IUATLD) annual conference. Participants included approximately 40 researchers from the International Pediatric Association (IPA), CDC, the World Health Organization (WHO), the US Agency for International Development (USAID), the National Institutes of Health (NIH), the National Institute of Allergy and Infectious Diseases (NIAID), the Fogarty International Center, the National Institute of Child Health and Disability (NICHD), academic institutions, and national TB programs from a number of countries in Sub-Saharan Africa, Asia, Latin America, and Eastern Europe. The goals of the conference were to highlight current gaps in knowledge about childhood TB, to assess research opportunities, and to begin to establish working partnerships and identify funding sources.

Data on the epidemiology of childhood TB are limited. In 1989, WHO esimated that there were 1.3 million annual cases and 450,000 deaths due to TB among children less than 15 years of age. More recent estimates of the burden of childhood TB have been difficult to obtain. Currently, WHO requests data from member countries about TB cases by age only for smear-positive cases. Since approximately 95% of children less that 12 years of age with TB disease are smear-negative, these published estimates greatly underestimate the burden of TB in this population. To begin to understand the burden of disease in children, more accurate estimates are needed. Plans are underway with WHO to consider expanding TB case notification practices for persons <15 years of age to address the current limitations on pediatric TB case information. This would greatly enhance the knowledge and understanding of global pediatric TB epidemiology.

Clinical research regarding childhood TB is also limited by the lack of a standard case definition. Generally, a diagnosis of TB in a child rests on epidemiologic and clinical information, chest radiograph, and rarely, bacteriologic confirmation. Consensus is needed on a clinical definition of childhood TB for use in research and program activities. Improved diagnostic tests for children represents a critical area for future research. Participants agreed that collaborative research is needed to study optimal case definitions and assess new diagnostic techniques in different settings.

Operational research is also needed to assess how well current worldwide strategies for directly observed treatment, short course (DOTS) are working to include children. Limited published data suggest that treatment outcomes are poor and default rates unacceptably high in low-income countries. Few countries have formal guidelines for the treatment of childhood TB, and programmatic activities such as contact tracing and treatment of latent infection are often not done in resource-poor settings. Additional research priorities identified during the conference included understanding the immune response of children to TB infection and disease and understanding the interaction of TB and HIV in children. Participants agreed that operational research using existing program data, as well as research on the immunology of childhood TB, and the relationship between TB and HIV infection in children are key areas for future research.

Participants from the conference will work to try to establish a Pediatric TB Subgroup under the Stop-TB Partnership to serve as a forum to move these initiatives forward. Priorities include expanded worldwide reporting of childhood TB cases, development of a working case definition, and the establishment of a pediatric TB research network.

This conference represents a first step to understanding the burden of childhood TB worldwide and renewing efforts to undertake research and program activities to reduce this burden.

-Reported by Lisa Nelson, MD, MPH, MS
Div of TB Elimination

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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