The World Health Organization released Monday new guidelines for the management of tuberculosis in children and adolescents, including the use of stool samples for diagnosing TB, a shortened treatment period for those with nonsevere forms of drug-susceptible TB, and the use of the two of the latest medicines for drug-resistant TB.
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The guidelines, which was released ahead of World TB Day on March 24, recommend that treatment for children and adolescents with mild or nonsevere forms of TB be shortened from six months to four months, and six months from 12 months for those being treated for TB meningitis.
WHO also recommends the use of bedaquiline and delamanid to treat drug-resistant TB in children of all ages, including newborns, making it possible for children to shift to an all-oral treatment course. This eliminates the use of injections that can be painful and cause serious side effects such as hearing loss.
WHO is also recommending the use of more decentralized TB care so children and adolescents can receive the care they need, including treatments, closer to where they live, “reducing delays and costs when accessing TB services,” according to Dr. Kerri Viney, team lead of the vulnerable populations, communities, and comorbidities unit at WHO’s global TB program, during a press conference.
Getting children’s lives back
A shorter treatment period helps children to get back to their lives earlier, and can save costs for affected families. It also helps reduce side effects.
The use of noninvasive specimens such as stools also help address some of the challenges in diagnosing TB in children. Sputum sampling is the most common method in detecting childhood TB, but children face difficulties in producing sputum. Methods such as gastric aspiration, where a tube is inserted in a child’s nose to reach the stomach, can be stressful.
According to Viney, an estimated 1.1 million children and young adolescents fall ill with TB every year, and almost half of them are under five years old. There is a huge gap in detecting TB among this age group, with less than half of them diagnosed for TB. In 2020, about 226,000 children died due to TB, and most of them were unable to access care. In addition, only 1.2 million of the 4 million children under 5 targeted for TB preventive treatment have received it in 2020.
The caveat
Organizations providing TB care such as Médecins Sans Frontières, welcome the new guidelines but also said that more innovation is needed, such as TB tests suited for remote settings.
“[W]e are still in desperate need of a TB test for children that can be used in even the most remote settings and that can test samples that are easy to collect, such as with mouth swabs or finger-prick blood,” Dr. Lazro Fidelle, TB operational research manager for MSF in Malakal, South Sudan, said in a statement.
MSF also called for price reductions for the TB test produced by Cepheid, which according to the organization remains “too expensive” at $9.98 per test in low- and middle-income countries, based on MSF analysis.
And while many welcome the introduction of stool sampling for TB diagnosis, the limited or lack of availability of skilled personnel and of the GeneXpert machine can pose challenges.
“The stool processing has been simplified enough for easy implementation. But still it requires access to a laboratory with skilled people to process stool and GeneXpert, which are still largely unavailable in many settings in India, where it is needed the most,” said Kalpana Sriraman, a researcher at the Foundation for Medical Research in Mumbai, in an email to Devex.
Another challenge, she said, could be “the low performance of these tests in children for drug resistance detection may still hamper decisions on shorter treatment recommendations for this population.”
Amid the release of the guidelines, WHO called for more investments in TB services and research. Global spending for TB diagnostics, treatment, and prevention in 2020 was only $5.3 billion, less than half of the global target of $13 billion a year by 2022, and down from $5.8 billion in 2020. TB research and development also requires an extra $1.1 billion a year, according to WHO.
About the author
Jenny Lei Ravelo@JennyLeiRavelo
Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.