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Steve Graham Centre for International Child Health, University of Melbourne

Child TB: global and regional update Ninth TAG meeting and NTP Managers Meeting 9-12 th December 2014 Manila. Steve Graham Centre for International Child Health, University of Melbourne International Union Against Tuberculosis and Lung Disease (The Union)

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Steve Graham Centre for International Child Health, University of Melbourne

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  1. Child TB: global and regional updateNinth TAG meeting and NTP Managers Meeting9-12th December 2014Manila Steve Graham Centre for International Child Health, University of Melbourne International Union Against Tuberculosis and Lung Disease (The Union) Child TB sub-group, Stop TB Partnership

  2. The Meeting on the Development of Child Tuberculosis Action Plans in the Western Pacific Region: HCMC, Viet Nam, March 2014 The objectives of the meeting were: • To share country experiences, lessons learnt and best practices; • To establish priorities and design activities for strengthening childhood TB initiatives in the Western Pacific Region; and • To form a task force to oversee the activities and progress. The meeting was attended by 21 country participants from 8 countries (Cambodia, China, Fiji, Lao PDR, Mongolia, PNG, Philippines and Viet Nam). Each country team was composed of focal point from NTP, maternal and child health programme and paediatric association. Also 17 observers participated the meeting from different technical agencies.

  3. Priorities for strengthening childhood TB activities in the WPR 1. Improved political commitment and collaboration with different stakeholders (e.g. MCH, EPI; partners like UNICEF, World Vision; paediatric associations, private providers) 2. Improved case detection 3. Improved case management and logistical management 4. Improved prevention (BCG, IPT, infection control) 5. Improved recording, reporting and data analysis (including private sector) 6. Improved awareness of community and capacity building of health care worker 7. Operational research

  4. Formation of a Regional Child TB Task Force Participants of the Meeting formed an informal taskforce called 'The Regional Childhood TB Taskforce' on the Development of Child TB Action Plans in the Western Pacific Region The Regional Childhood TB Taskforce will support members to finalise national action plans and convene a regional workshop (with partners). • Chair: Steve Graham • Co-Chair: Dr James Amini (PNG); Dr Nguyen Thein Huong (Viet Nam) • Vice Chair: Dr Celine Garfin (Philippines); Dr Lin Zhou (China) • Members: All participants of the meeting • Secretariat: WPRO,WHO Next meeting: Union APR conference, Sydney, August 2015

  5. Objectives and activities of the taskforce • Increase awareness of the child TB disease burden in the Asia-Pacific region • Assist the development of pragmatic, contextualized national child TB action plans • Monitor & support implementation of these plans • Provide an education resource (training) • Facilitate collaboration/integration between programs for TB and maternal and child health

  6. Childhood tuberculosis: out of control? Donald PR. Curr Opin Pulm Med 2002 Child TB at the new millenium JR Starke

  7. Putting child TB on the global public health agenda Child TB subgroup of Stop TB Partnership formed 2003 Children recognised as a vulnerable group in need of increased case-finding: 2009 International Child TB Meeting, Stockholm, 2011

  8. TB in the context of maternal and child health Increasing recognition that TB is an increasingly important cause of morbidity and mortality in infants and young children globally Pregnancy-related TB – maternal and infant outcomes Orphans due to TB – estimated to be around 9 million globally Catastrophic economic costs of TB – families living with TB TB in adolescents – uncertain burden and specific management issues

  9. Millennium Development Goals

  10. Innovative approaches Community-based Wider health sector Preventive therapy Operational research

  11. Roadmap for Childhood Tuberculosis Launched Washington DC, October 1st 2013

  12. Situational analysis a critical first step

  13. “Know your epidemic” TB in women – best estimate 3,300,000 cases Deaths: 330,000 HIV negative 180,000 HIV positive TB in children (0-14 yrs) actual reported 275,000 15% smear-positive 54% smear-negative 31% EPTB Best estimates: 550,000 cases and 80,000 deaths

  14. Child TB working group and NTP

  15. Age and sex-specific notification rates of new smear-positive TB cases for the Western Pacific Region, 2012 Hiatt T & Nishikori N. WPSAR 2014

  16. Age and sex-specific notification rates of new smear-positive TB cases for the Western Pacific Region, 2012 Hiatt T & Nishikori N. WPSAR 2014

  17. Risk of TB disease following infection by age Adapted from Marais B, et al. Int J Tuberc Lung Dis 2004

  18. Gap in surveillance Incident (new) TB cases Under-diagnosed Gap Under-reported TB case notifications known to the NTP

  19. Poor recording and reporting Incident (new) TB cases Under-diagnosed Gap Under-reported TB case notifications known to the NTP

  20. From under-diagnosis Incident (new) TB cases Gap Under-diagnosed Under-reported TB case notifications known to the NTP

  21. to over-diagnosis Not TB cases TB case notifications known to the NTP Incident (new) TB cases Under-diagnosed Under-reported

  22. Only 1.6% of 4,821 cases in children were registered with NTP

  23. Diagnosis of child TB in Java and level of care Lestari T, et al. BMC Pub Health 2011

  24. Burden of child TB in four provinces of PNG: 2005-6Law I, et al. Poster – The Union Global Lung Health Conference 2008 Child TB accounts for 30% of total TB burden

  25. Pattern of EPTB disease in children in four provinces of PNG: 2005-6 EPTB represented 39% of childhood TB cases

  26. NATIONAL TB PROGRAMPAPUA NEW GUINEA MANUAL ON MANAGEMENT OF CHILDHOOD TUBERCULOSIS

  27. Child TB working group and NTP

  28. Rapid development of diagnostics Tuberculin Skin Test 1890 Chest X-ray 1896 History Bacteriology 1882

  29. Diagnostic yield for pulmonary TB comparing children to adults Xpert cannot be used to rule out TB Xpert needs research on implementation to inform optimal usage in children

  30. Union – MSF Operational Research Courses TOTAL: 212 participants Europe Georgia Ukraine Estonia Latvia Belorussia Moldova Armenia Azerbaijan Denmark Italy Asia India Bangladesh Pakistan Afghanistan Nepal Bhutan Sri Lanka Timor Leste Singapore China Mongolia Uzbekistan Vietnam Myanmar Indonesia Cambodia South Pacific New Caledonia Cook Islands Tonga Marshall Islands Federated States of Micronesia Solomon Islands Vanuata Fiji South America Brazil Peru Africa Kenya South Africa Ethiopia Malawi Zimbabwe Benin Somaliland Rwanda Uganda Ghana Tanzania Burundi Madagascar Lesotho Swaziland Democratic Republic of the Congo Sudan Mozambique Nigeria Somalia Sierra Leone Liberia

  31. MANAGEMENT OF TB IN CHILDRENIN VIETNAM

  32. Activities

  33. Community awareness – and support health worker! 12,750 posters 554,400 leaflets

  34. Community contact screening in Viet NamOct 2012-Dec 2013

  35. NATIONAL PLAN FOR THE MANAGEMENT OF TB IN CHILDREN: 2015-2020 Goal: To strengthen detection, treatment and preventive therapy for Vietnamese children towards decreasing childhood TB morbidity and mortality in Vietnam.

  36. Regional activities in 2014 • WHO WPRO, Regional taskforce, Viet Nam, March • China National Child TB, Beijing, August • Global consultation on child TB for high burden countries in EMRO, SEARO and WPRO, Indonesia, September

  37. “ There are many contributions which the pediatrician can make to a TB control program. First the negativism about tuberculosis so prevalent in pediatrics must be overcome…” Edith Lincoln, 1961 Donald PR. Edith Lincoln, an American Pioneer of Childhood Tuberculosis. Pediatr Infect Dis J 2013

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