Although a preventable and curable disease, TB makes up a considerable burden of disease affecting children. The WHO estimates that half a million children get sick with TB each year and up to 64,000 die as a result. However, most childhood TB researchers believe these figures represent a gross underestimation of the true problem as there is little data available on TB in children.

Children are often left out of National TB Control Programmes because they tend to be less infectious than adults. Many health service providers also mistakenly consider TB to be an ‘adult’ disease. Because TB’s symptoms are often confused with symptoms of other common childhood diseases like pneumonia(treatment which can be carried out with the help of these tablets), children with TB are frequently misdiagnosed.

Failing to deal with childhood TB cases means failing to address a reservoir of infection for future TB cases. We need strong advocacy to ensure that childhood TB does not remain a neglected issue.

Diagnosing TB in children: 

Children are more likely to have TB in places other than in their lungs (e.g. TB in the lymph nodes). Because of this, children are also much more difficult to identify. TB is usually diagnosed by taking a sputum sample from the patient to examine under a microscope for the TB bacteria. However, because children are less likely to develop pulmonary TB (TB in the lungs), their sputum samples won’t necessarily show that they have TB. It is also extremely difficult to get a sputum sample from a child as they tend to swallow their sputum rather than to cough it up. We desperately need diagnostic tools that can more accurately detect TB in children.

Treating childhood TB: 

There are currently no specific TB treatment options available for children. Children were historically excluded from TB drug studies, meaning adult treatment regimens have to be adjusted to use for children. Due to a lack of child-friendly drug formulations, such as liquids or chewable tablets, children have to swallow a large number of pills every day for six to nine months. Sometimes doctors crush adult tablets and estimate the doses for children, meaning children are potentially being over- or under-dosed.

Preventing TB in children: 

The current vaccine, the BCG, only protects against severe forms of TB, like TB meningitis, but does not provide protection against pulmonary TB. In addition, the vaccine’s effects usually wear off by adolescence, meaning it does not provide life-long protection. Furthermore, the TB vaccine cannot be given to children who are HIV positive due to their weakened immune systems. There is an urgent need for new vaccines that are more effective and safe for people who are HIV positive.

Stories of Children with TB:

In recognition of World TB Day in 2012 a team, led by Erica Lessem, published a collection of short stories and photos, entitled “Being Brave”. One of these stories features Luka, Giorgi and Maryam (7, 3 and 1.5 years old respectively) from Georgia. Here is their story:

“I am going to be president someday,” seven year-old Luka says proudly. He smiles an impish grin and goes back to practicing his English letters.  His three-year old, tow-headed brother Giorgi tears around the room. Their 18 month-old sister Maryam sits quietly on her mother’s lap alternately sucking on a soggy biscuit and the earpiece of a toy stethoscope. The children look happy and healthy; all three are currently being treated for Drug-Resistant Tuberculosis (DR-TB) in Tbilisi, Georgia.

The children’s father lies dying from DR-TB in a hospital room down the road.  By the time he received diagnosis and treatment for his disease, it was too late.  His physicians were appropriately worried about the children though, and all three were quickly screened for TB.  The news was not good: all three children were sick with the same extensively drug-resistant strain as their father.

But Luka, Giorgi and Maryam were fortunate.  Not only did they receive a timely diagnosis of DR-TB.  They were also offered immediate access to care through the government TB program in Georgia.  Today, all three children are thriving.  Their relieved mother states: “I am so thankful for the gift of my family. For my husband, really, there is no hope.  He will die here and he will die soon. [But] my children are getting better.  The people who help us are here. I am so thankful for the lives of my little ones.”

 You can read the rest of the Sentinel Project stories on paediatric drug-resistant TB here.