First-Ever Targeted Roadmap Outlines Steps to End Childhood TB Deaths

Shobha Shukla *

The "Roadmap for Childhood Tuberculosis: Towards Zero Deaths" - the first ever plan which specifically addresses TB in children and outlines the path towards zero deaths from childhood TB - was jointly launched on 1st October 2013, in Washington DC by global leaders in TB control: the International Union Against Tuberculosis and Lung Disease (The Union), the World Health Organization (WHO), the Stop TB Partnership and other partners.

"If we can shift TB diagnosis and treatment out of specialized programs and into other existing maternal and child health activities, we automatically gain reach and scale. Combining that scale with investment in tools and medicine would save tens of thousands of lives," said José Luis Castro, Interim Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union).

More than half a million children (around 530,000) become ill with TB every year with 70%–80% of them having pulmonary TB and the rest are affected by the disease in other parts of the body (extra-pulmonary TB). In case of India, as per the Revised National TB Control Programme (RNTCP) Annual Report 2013, it is estimated that 10% of total TB load is found in children. The number of paediatric TB cases registered under RNTCP has shown an increasing trend in the past five years and in 2012, about 81,482 cases were notified. However the actual burden of childhood TB (globally as well as in India) could be much higher because TB in children often goes undiagnosed.

Every day over 200 children under the age of 15 die worldwide from this preventable and curable disease, bringing the annual death toll to 74,000 in case of HIV-uninfected children.

The roadmap estimates that these lives could be saved by spending US$120 million a year, which includes US$ 40 million for antiretroviral therapy and preventive therapy for children co-infected with TB and HIV. This is a small price tag for a global disease and is needed to improve detection, develop better medicines for children and integrate TB treatment into existing maternal and child health programmes.

Dr Mario Raviglione, Director, Global Tuberculosis Programme at WHO, rightly feels that, "Any child who dies from TB is one child too many. As we know, TB is preventable and treatable; this roadmap shifts our focus from the challenges we face to immediate actions we can take."

Ten Action points to Save Young Lives

The Roadmap recommends ten action points at national and international levels to tackle childhood TB:

(i) Include the needs of children and adolescents in research, policy development and clinical practices
(ii) Collect and report better data, including data on prevention
(iii) Develop training and reference materials for health care workers
(iv) Foster local expertise and leadership
(v) Use critical intervention strategies (like intensive case finding, contact tracing, preventive therapy, early diagnosis, and uninterrupted supply of standard anti TB medicines for children)
(vi) Engage key stakeholders
(vii) Develop integrated family-centred and community-centred strategies
(viii) Address research gaps and develop new diagnostics, medicines and vaccines
(ix) Meet funding needs for childhood TB
(x) Form coalitions and partnerships to improve tools for diagnosis and treatment.

TB services for children should be mainstreamed into existing children’s health services. However, moving to this type of family/community-centred approach will require effective collaboration and joint planning among TB control programmes, maternal and children’s health services, and HIV services. "We must ensure systems are in place to serve children through existing health, community, and child-centered services," said Dr Tom Kenyon, Director of the Centre for Global Health at the US Centres for Disease Control and Prevention.

The timeline for key actions to implement the plan has also been formulated--

Short term by 2015: Increased action to implement contact investigation and IPT to detect and manage TB in children; Advocacy for research on new diagnostics, drugs and vaccines for childhood TB; Improved recording and reporting of data on childhood TB; Scaling up of capacity building of health workers to detect and manage children with TB Antenatal screening for TB– detect, treat or prevent TB in mothers

Medium term by 2020: Improved prevention, detection, diagnosis and management of TB in children and pregnant women; Development of new diagnostics suitable for children; Inclusion of children in trials of new diagnostics and drugs

Long term by 2050: Test for latent TB with ability to predict disease progression in children; Vaccines to prevent infection and disease in children and adults; Point of care accurate test for childhood TB; Shorter, child-friendly regimens for both infection and disease; Implementing integrated approaches across the health system to address TB in children.

"Current diagnostics, toxic drugs and inadequate drug formulations are insufficient to respond to the needs of children with TB,” says Colleen Daniels, Director TB/HIV at Treatment Action Group (TAG). "New tools will be a crucial part of addressing TB in children and current investments are minimal at best. Much more investment and commitment to childhood TB is urgently needed now".

The Childhood TB Roadmap is a call to action for all stakeholders in child health to move the world towards zero TB deaths in children. Achieving this goal requires sustained advocacy, greater commitment, mobilization of increased resources and a joint effort by all stakeholders involved in providing health care for children and in TB control. Activists said to Citizen News Service – CNS that greater awareness and understanding of childhood TB will have to be promoted.

Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership, rightly says "If a small child can summon the bravery to complete a six-month TB treatment, the global community must be similarly brave in its ambitions to defeat the epidemic. To get to zero TB deaths, we must focus on the most vulnerable groups and children are the most vulnerable of all. The steps outlined in this roadmap are simple and low-cost. We owe it to the children of the world to put them into action."