WHO Updates on TB Management in Children and Adolescents

Incorporating new evidence on the treatment of Tuberculosis (TB), the World Health Organisation (WHO) releases updated guidance on the management of TB in children (under 10 years of age) and adolescents (10–19 years of age) that also revolves around patient-centered recommendations for diagnosis, treatment, and prevention.

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TB remains one of the world's deadliest infectious killers. Each day, over 4100 people lose their lives to TB, and close to 30,000 people fall ill with this preventable and curable disease. The situation is even worse for children and adolescents with TB. In 2020, an estimated 63% of children and young adolescents below 15 years with TB were not reached with or not officially reported to have accessed life-saving TB diagnosis and treatment services; the proportion was even higher - 72% - for children under 5 years.

"Children and adolescents with TB are lagging behind adults in access to TB prevention and care", said Dr. Tereza Kasaeva, Director of WHO's Global TB Programme.

Recent Recommendations

• In children with signs and symptoms of pulmonary TB, Xpert Ultra should be used as the initial diagnostic test for TB and detection of rifampicin resistance on sputum, nasopharyngeal aspirate, gastric aspirate or stool, rather than smear microscopy/culture and phenotypic drug susceptibility testing (DST).
• In children with presumptive pulmonary TB attending health care facilities, integrated treatment decision algorithms may be used to diagnose pulmonary TB.
• In children and adolescents between 3 months and 16 years of age with non-severe TB (without suspicion or evidence of multidrug- or rifampicin-resistant TB (MDR/RR-TB)), a 4-month treatment regimen (2HRZ(E)/2HR) should be used.
• In children with MDR/RR-TB aged below 6 years, an all-oral treatment regimen containing bedaquiline may be used.
• In children with MDR/RR-TB aged below 3 years, delamanid may be used as part of longer regimens.
• In children and adolescents with bacteriologically confirmed or clinically diagnosed TB meningitis (without suspicion or evidence of MDR/RR-TB), a 6-month intensive regimen (6HRZEto) may be used as an alternative option to the 12-month regimen (2HRZE/10HR).
• In high TB burden settings, decentralized TB services may be used in children and adolescents with signs and symptoms of TB and/or in those exposed to TB.
• Family-centred, integrated services in addition to standard TB services may be used in children and adolescents with signs and symptoms of TB and/or those exposed to TB.

Reference

1. WHO News on World TB Day
2. WHO consolidated guidelines on tuberculosis Module 5: Management of tuberculosis in children and adolescents. World Health Organization March 2022.

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