Childhood tuberculosis in spotlight at AIDS 2012
Childhood tuberculosis (TB) has been neglected for a long time and in terms of the global policy the focus has been on adult tuberculosis. To add fuel to fire, presentation of the disease is less specific in children, and while diagnosis is difficult, treatment is also very child unfriendly.
A press conference organized by Citizen News Service (CNS), a partner of Stop TB Partnership, during the recently concluded XIX International AIDS Conference (AIDS 2012) held in Washington DC, focussed upon various issues besetting childhood TB which affects at least half a million children (and this could very well be an under estimate), killing up to 70,000 of them each year. Some ten million children have been orphaned due to TB and many more have had to quit school to care for relatives or provide a living for their families.
A CNS publication report “Hearing the unheard voices - saving children from TB” based on e-consultation and key informant interviews conducted by CNS along with over 50 partner organizations was also released in this press conference at AIDS 2012.
The need for better diagnostic tools and simpler treatment regimens was emphasized by one and all.
Judith Mandelbaum-Schmid, Team Leader for Communications, Stop TB Partnership Secretariat, rued the fact that "TB is a killer disease and yet curable at the cheap price of 3 cents a day. Yet children all over the world are becoming sick and dying of it. Even those who survive may be left blind, paralyzed or with other disabilities.
Children with HIV are at higher risk of TB. It is important to screen pregnant mothers for TB as is being done for HIV. Simple algorithms should be provided to healthcare workers so that they are able to find more children and people undiagnosed with TB, and be more alert about HIV-TB co infection. We need more research as it is difficult to diagnose TB and there are no child friendly formulations. We need effective vaccines."
Through a live broadcast, Dr Steve Graham, Chair, Stop TB Partnership's Child TB Working Group, and Child Lung Health consultant, International Union Against TB and Lung Disease (The Union) stressed that to achieve the millennium development goals (MDG) - 4, it is imperative to address childhood TB as it is a cause of mortality in children and adults. He and Dr Stephen Murray, Senior Medical Officer, TB Alliance felt the need for non-sputum based diagnostics as only 10-15% of children with TB are smear-positive, while most of them often have smear-negative TB. Dr Graham felt that National TB programs must include maternal and child health and children should not be forgotten in research related to new diagnostics, treatment and prevention. Dr Murray felt sorry at the absence of new formulations to deliver adequate dose to children as normally drugs are formulated for adults first and it is only after they are rolled out that doses for children are fixed. He said that, “We need to think of and target children from early stages of drug development process - formulation and dosing. It is technically not difficult to make child friendly formulations - it is just a matter of finding resources."
Kayt Erdahl, Technical Officer, HIV/AIDS and TB Global Programme at PATH, hoped that we could find children with TB early, diagnose correctly and treat them adequately. She gave the example of Tanzania where PATH works closely with the Ministry of Health, Tanzania, to develop paediatric guidelines and also to provide training to healthcare workers in maternal and child health wards and outdoor patients' department (OPDs) so that they look for TB in children and are able to diagnose it early. "We should also put new diagnostic and treatment tools in place when they become available. It is important to do contact tracing for children diagnosed with TB (their parents, siblings etc)" said Kayt.
In his live broadcast, Dr Michael Brennan, Senior Advisor (Global Affairs), Aeras, informed that as of now there are 12 new TB vaccine candidates in the research pipeline/ trials, three of which have been shown to be safe in HIV positive adults too, and if all goes well there may be a new TB vaccine within a decade. He said that, "There is hope that we will have phase-2b results of these vaccine candidates that will provide us with the information if these vaccines can be effective in children. If effective then we will move on to large multi-centric phase-3 efficacy clinical trials. There is large resource gap as each of the phase-3 trials costs USD 100 million."
David Bryden, Stop TB Advocacy Officer, RESULTS, felt the need for doing more for TB, just as we are doing for HIV, in children. According to David, "PEPFAR programme should integrate TB. Currently only 2% of PEPFAR money is spent on addressing TB-HIV co-infection. We have seen cuts in TB USAID budget. If HIV positive pregnant women have TB it doubles their chance of passing TB to their new-born. It is important that every HIV education programme includes TB education as well."
Childhood TB certainly cannot be ignored. Children get TB infection from adults, and unless we do a better job in caring and controlling adulthood TB, controlling TB in children will continue to remain a distant dream. Stopping childhood TB will not happen without support from countries at every level and effective collaboration between national TB programmes and other development programmes such as those on nutrition, food security, HIV, maternal and child health, among others. Governments should invest in and support the development of new and improved tools for preventing, diagnosing and treating TB in children and adults, while community education about TB will help raise awareness about transmission and prevention practices that reduce the incidence of childhood TB infection.
-Asian Tribune -