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Children and Tuberculosis Exposing a Hidden Epidemic

Children and Tuberculosis Exposing a Hidden Epidemic. Mandy Slutsker September 21, 2011. TB basics. TB is an infectious disease caused by bacteria that is spread through the air Latent TB infection vs. active TB disease 1/3 of world’s population has latent TB

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Children and Tuberculosis Exposing a Hidden Epidemic

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  1. Children and TuberculosisExposing a Hidden Epidemic Mandy Slutsker September 21, 2011

  2. TB basics • TB is an infectious disease caused by bacteria that is spread through the air • Latent TB infection vs. active TB disease • 1/3 of world’s population has latent TB • 9.4 million get active TB disease every year • Drug resistance, link with HIV

  3. Types of active TB • Pulmonary vs. extrapulmonary • Smear positive vs. smear negative • Drug susceptible vs. drug resistant

  4. How is TB different in children? • Most children are smear-negative • Difficult to diagnose • Children are prone to severe types of TB such as TB meningitis

  5. How many kids get TB? We’re not exactly sure. Here’s why: • Most countries only report ‘smear positive cases’. Only 10-15% of children are smear positive • Most cases go unreported • Best numbers we have are from the WHO (2009): every year, over 1 million children get TB and ~176,000 die as a result

  6. Can children get drug resistant TB? • Yes, children get MDR-TB. However, WHO surveys only include adults • Studies in South Africa show 9% of childhood TB cases are drug resistant • It is curable, but takes medical care and extremely expensive treatment • Far cheaper to prevent MDR-TB by ensuring kids are properly treated for drug-susceptible TB

  7. Risk Factors • Poverty • Young Age • Malnutrition • Orphans and Vulnerable Children • HIV • Maternal TB

  8. Diagnosing TB in children • No gold standard; diagnosing often done by trial and error. • WHO has yet to approve Xpert MTB/RIF for use in children • However, a preliminary study from July 2011 show the test may be effective in children

  9. How do we treat children with TB? • No child-specific TB drugs exist • Often, health workers crush adult tablets and estimate doses for children • We need a Fixed Dose Combination (FDC) for children

  10. How can we prevent TB in children? Answer: the Four I’s • Intensified Case Finding • Isoniazid Preventive Therapy • Infection Control • Integration

  11. What do need to tackle childhood TB? • Child-friendly diagnostics • Fixed Dose Combination treatment • TB vaccine • Children included in clinical trials …All this requires increased resources!

  12. A call to action • Fighting childhood TB must become a global health priority • Universal access to current available tools • Integrate TB services with child health primary care • Include children in clinical trials • Innovative research • Children with HIV should be placed on ART

  13. Anthony’s story

  14. Stories from India and Kenya

  15. Education • Children with TB fall behind in school • Harms ability to earn good wages in the future • When parents are sick, children leave school to earn money for the family

  16. Poverty • Parents take time off work to care for sick children, results in loss of family income • High cost of health care may force families to sell belongings to pay for care and treatment

  17. The End

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