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Current Epidemiology of Pediatric Tuberculosis
Sushant Satish Mane1, Pragya Shrotriya2
1State Pediatric Center of Excellence for TB, Department of Pediatrics, Grant Govt. Medical College, Sir JJ Group of Hospitals, Mumbai, India. drsush2006@gmail.com.
Insights
Childhood tuberculosis (TB) is a significant global health issue, particularly in India. Addressing the 56% detection gap in pediatric TB cases is crucial for effective elimination strategies.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Tuberculosis (TB) remains a leading cause of death globally, with children serving as key reservoirs for transmission.
- Pediatric TB constitutes a substantial burden, with India accounting for 31% of the global load, yet only 6-7% of National Tuberculosis Elimination Programme (NTEP) cases.
- A significant 56% detection gap in India highlights missed pediatric TB cases, including underestimation of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) in children.
Purpose of the Study:
- To underscore the critical need for successful detection and treatment of TB in children for effective TB elimination.
- To highlight the epidemiology and risk factors associated with childhood TB in India.
- To inform resource allocation and policy-making by understanding pediatric TB burden.
Main Methods:
- Review of existing data on pediatric TB prevalence and treatment under the NTEP in India.
- Analysis of the estimated detection gap for TB and MDR/RR-TB in children.
- Identification and discussion of various risk factors contributing to TB exposure, infection, and disease in children.
Main Results:
- Children represent a significant portion of the TB burden, yet are underdiagnosed and undertreated.
- India faces a substantial detection gap (56%) for pediatric TB, with severe underreporting of MDR/RR-TB.
- Numerous factors, including environmental, genetic, and socioeconomic, influence TB risk in children.
Conclusions:
- Effective TB elimination strategies are impossible without addressing pediatric TB case detection and treatment.
- Understanding the natural history and epidemiology of childhood TB is vital for identifying vulnerable populations.
- This knowledge is essential for targeted resource allocation and informed policy decisions to combat pediatric TB.
Abstract:
Tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the leading causes of death worldwide. Children act as reservoirs of infection out of which future cases develop. Without the successful detection and treatment of TB infection and disease in children, elimination strategies for TB will be ineffective. India has a severe problem with TB in children, which accounts for around 31% of the global pediatric TB load. However, over the past 10 y, children have consistently made up 6-7% of all patients treated yearly under the National Tuberculosis Elimination Programme (NTEP). There is an estimated detection gap of 56% in India, which is the reason for many missed cases of TB in children. Only 3% of children less than 14 y with MDR/RR-TB, are reported from India, which again is an underestimation of the actual incident cases. Population density, housing and living conditions, environmental conditions, cultural practices, age of the child, exposure to tobacco and other environmental pollutants, the virulence of the mycobacterial strain and their genetics, host genetics, BCG vaccination, malnutrition, immunodeficiency are some of the risk factors for TB exposure, infection and disease in children. Understanding the natural history as well as the epidemiology of childhood TB is important to assess which children are the most vulnerable. It would also guide us in understanding the burden of pediatric TB on a regional, national, or global level, thus facilitating the appropriate targeting of health resources and also guiding policy-making decisions.
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