Children missing out on in battle against TB

The number of children diagnosed with tuberculosis only represents the tip of the iceberg, according to the University of Sydney’s Associate Professor Ben Marais, a specialist in childhood tuberculosis writing in the latest issue of The New England Journal of Medicine.

“Many doctors think children don’t get TB,” said Dr Marais, a paediatrician based at the Children’s Hospital at Westmead. “They do, in fact young children are exceptionally vulnerable because of their underdeveloped immune systems.”

Autopsy results show that tuberculosis is a major killer of children in many parts of the world but most cases remain undiagnosed since the standard test is not effective in children, Dr Marais said.

“But it is possible to make an accurate diagnosis in the majority of children without sophisticated tests, and there are referral pathways if child health workers see children who may have TB.”

Tuberculosis in both adults and children in Australia is relatively rare and Dr Marais says they would see less than a dozen cases a year at the Children’s Hospital at Westmead.  Internationally however, TB is a major cause of disease and death with an estimated 8.8 million cases and nearly 1.5 million deaths ascribed to it in 2010.

Best estimates are that children contribute 10-15 percent of all cases in TB endemic areas, but they comprised only 3.5 percent of cases reported in 2010 from the 22 countries with the highest TB disease burdens.

Despite the current low numbers, TB remains an important health issue for Australia, he said. “High disease rates in countries such as Papua New Guinea, Indonesia, Vietnam, China and India are complicated by a growing incidence of drug resistant strains.” 

“The majority of children diagnosed with TB in the clinics at Westmead are from immigrant families, but indications are that about one third of children get infected locally, suggesting on-going TB transmission within communities.”

“It is important that child health workers are trained to recognise children at risk of having TB, to promote better prevention strategies and make sure that adequate diagnosis and treatment is readily accessible.”

The article, Tuberculosis in Children, co-authored by Dr Carlos Perez-Velez from University de Antioquia in Colombia, was commissioned by the New England Journal of Medicine to improve understanding of the disease among doctors and to outline best practice guidelines.

Associate Professor Ben Marais is deputy director of the University of Sydney’s Emerging Infections and Biosecurity Institute.