Children with TB below the health radar

Tuberculosis (TB) affects nearly a million children globally every year and up to 70,000 die from this...

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Tuberculosis (TB) affects nearly a million children globally every year and up to 70,000 die from this preventable and curable disease per annum.

Problems in detection, difficulties in diagnosing, and the fact that children rarely spread the disease have kept paediatric TB off the public health radar, but this is changing.

"If you see an adult with TB there's going to be a child who's exposed and at high risk," said Anneke Hesseling, Director of the Paediatric TB Research Programme at the Desmond Tutu TB Centre at Stellenbosch University in Western Cape Province.

According to the 2012-2016 National Strategic Plan for HIV, sexually transmitted infections (STI) and TB, South Africa has the third highest level of TB in the world.

New infections have increased by 400 percent over the last 15 years, approximately one percent of over 50 million people per year develops active TB, and more than 70 percent of TB patients are co-infected with HIV.

In this context, the number of children thought to be infected with TB is huge.

Hesseling estimates that in TB-endemic areas the disease will be active in 15-20 percent of children, but reliable figures are hard to come by.

"Up to the early 2000s there was little money for research into childhood TB.

"If we wanted to do research… we had to attach it to an adult study," noted Simon Schaaf, who has been conducting research into paediatric TB with Hesseling and others at the Desmond Tutu TB Centre.

Paediatric TB differs from adult TB in several ways. First, the available diagnostic tools make it very difficult to confirm TB in a child.

The most common mode of testing, coughing up a sample of sputum to be checked under the microscope for the bacteria, often does not work because young children are usually unable to produce a sample.

Even when a child can provide a sample, it will often come back negative because children are usually infected with far fewer organisms.

And as yet there is little evidence that new molecular tests like GeneXpert will assist in paediatric diagnosis.