Khopotso Bodibe : 14 July 2011
Improved and sustained efforts to diagnose and treat TB need to be made to address tuberculosis infection among children.
This is according to the National Institute for Communicable Diseases (NICD), after results of a clinical study it conducted showed that prophylaxis with Isoniazid does not prevent TB in children.
Working from the premise that when taken daily, Isoniazid or INH prevents the development of tuberculosis in adults who have HIV, the study recruited over 500 HIV-positive children and about 850 HIV-uninfected children that were born to HIV-positive mothers in high-risk TB areas of Johannesburg, Cape Town and KwaZulu-Natal. The study sought to investigate whether the use of Isoniazid at a very early age - three to four months - can protect children from developing TB as most infection occurs in children under two years of age. It was a randomised study where one group of children received the actual Isoniazid pill and the other a placebo. The intervention proved to be ineffective. Shabir Madhi is the Director of the National Institute for Communicable Diseases (NICD).
"Unfortunately, what the study showed is that, firstly, even when HIV-infected children are receiving antiretroviral treatment, as much as 20% of them will actually develop tuberculosis in the first two years of life. So, it tells us that even with antiretroviral treatment HIV-infected children remain highly susceptible to developing tuberculosis", says Professor Madhi, Director of the National Institute for Communicable Diseases (NICD).
"The results of the study, unfortunately, showed as well that the use of Isoniazid prophylaxis aimed at preventing TB, unfortunately did not work in reducing the risk of developing TB infection in the HIV-uninfected children that were born to HIV-infected mothers", Professor. Madhi continues.
In HIV-negative children, it was found that about 4 - 5% get infected with TB annually in the first two years of their lives. Professor Madhi says to participate in the study the young ones had to come from a household with no prior history of TB infection. Yet, some of the children did develop TB.
"What we found, subsequently, is that of all of the children that developed tuberculosis in this particular study, only one-third of them actually developed tuberculosis in the presence of another member in that household having TB, which tells us that the majority of children that develop tuberculosis, the exposure to the infectious case is actually unknown. And the frightening part of that is that it goes against the dogma that children usually develop TB mainly because of household contact", he says.
"What that tells us is that children mainly become infected with tuberculosis because of the adults that are surrounding them. And what it tells us is that we need to basically improve our targeting of the management of tuberculosis in adults to prevent the child from becoming infected because all of this infection and all of this disease that's happening in children is almost a measure it's a marker of how well we're doing in terms of controlling tuberculosis in adults because if we're able to control tuberculosis in adults these children won't become infected. The adults are really the sources of infection of tuberculosis for these young children", adds Professor Madhi.
This means more needs to be done to identify TB cases in communities.
"That has got extremely important implications in terms of how we need to go about looking out for TB in children, but more importantly, how much more important it is that we actually intervene at the community level amongst adults in preventing TB because unless we're able to reduce that overall community exposure of TB which children are exposed to, we're not going to reduce the burden of TB in children purely by targeting the prophylaxis of children that have a known household exposure".
Prof. Madhi says there was a fair amount of confidence that Isoniazid would work as an intervention to protect children against TB when the research was initiated. Now researchers have learned that Isoniazid prophylaxis in children is a quick-fix where long-term solutions are needed. Madhi says he hopes that the Gene-Xpert PCR test which is able to make a TB diagnosis almost immediately instead of in weeks, will be widely used as it will have positive spin-offs.
"Now what that strategy will allow us to do is that it will allow us to basically make sure that we're treating the infectious cases that are coming to our health facilities immediately and, hopefully, reduce the number of people that end up not being treated. But, more importantly, is active surveillance for TB going down to the community level knocking on doors finding anyone that has got a cough, as an example getting them to agree to send a sample for testing and then identifying these TB cases at a very, very early stage before they start spreading the bug throughout the community. And that's the only way we're going to win this game. We're not going to win the game in South Africa in protecting against TB by trying to prevent it with Isoniazid prophylaxis. There's just too much TB circulating for short-cut interventions", he says
http://allafrica.com/stories/201107140012.html
Showing posts with label Tuberculosis(children). Show all posts
Showing posts with label Tuberculosis(children). Show all posts
Sunday, 17 July 2011
Thursday, 24 March 2011
TUBERCULOSIS: In Children: Call for Action
CALL TO ACTION for CHILDHOOD TB
We, participants gathered at the ‘International Childhood Tuberculosis Meeting’ held March 17-18, 2011 in Stockholm, Sweden recognize that:
o Worldwide, about 1 million TB cases occur each year in children under 15 years of age.
o The true burden of TB in children is unknown because of the lack of child-friendly diagnostic tools and inadequate surveillance and reporting of childhood TB cases.
o Children with TB infection today represent the reservoir of TB disease tomorrow.
o Children are more likely to develop more serious forms of TB such as miliary TB and TB meningitis resulting in high morbidity and mortality.
o Despite policy guidelines, the implementation of contact tracing and delivery of isoniazid preventive therapy (IPT) to young and HIV-infected children is often neglected by public health programmes.
o Most public health programs have limited capacity to meet the demand for care and high-quality services for childhood TB.
o TB care for children is not consistently integrated into HIV and care and maternal and child health programs.
o BCG, the only licenced TB vaccine, has limited efficacy against the most common forms of childhood TB and its effect is of limited duration.
o Due to inadequate case detection it is estimated that a large number of children suffering from TB are not appropriately treated. This is further compounded by drug stock outs and the lack of child-friendly formulations of drugs for TB treatment and prevention.
o Children are rarely included in clinical trials to evaluate new TB drugs, diagnostics or preventive strategies.
To address this current situation, we, the undersigned, call for:
o National TB programmes to include and prioritize childhood TB in their national strategic plans in order to address millennium development goals for children and pregnant women.
o All health care providers to integrate childhood TB into their services.
o The scientific community to include children—of all ages—in clinical and operational studies.
o TB drug and diagnostic product developers to specifically include children in development plans and implementation of research at an early stage.
o Donors to encourage collaboration with researchers, local communities, TB control programmes and other stakeholders to address the growing problem of childhood TB concentrating on:
o Innovative research to develop child-friendly TB diagnostics, drugs, biomarkers and vaccines
o The strengthening of public health facilities and services so that mothers and children with and without HIV can receive appropriate TB care
o Providers of technical assistance to invest in building local technical and programmatic capacity to prevent, diagnose and treat TB in children in all age groups.
o The WHO to accelerate in-country adoption and use of childhood TB guidelines.
o Policy makers to adopt the existing and new WHO recommendations for childhood TB, evaluate implementation, scale-up and assess the impact of implementation strategies.
o Civil society to demand equitable prevention, diagnostics, treatment and care services for childhood TB and to monitor the scale- up of these services.
To ensure that all children exposed to TB or suffering from TB are correctly managed and receive the appropriate treatment, the individuals and institutions signing on to this call to action, pledge to advocate for universal access to prevention, diagnosis and treatment of TB for people of all ages.
We furthermore call on the international community to endorse this call for action to ensure that there is capacity to address the needs of children with TB.
http://www.stoptb.org/
We, participants gathered at the ‘International Childhood Tuberculosis Meeting’ held March 17-18, 2011 in Stockholm, Sweden recognize that:
o Worldwide, about 1 million TB cases occur each year in children under 15 years of age.
o The true burden of TB in children is unknown because of the lack of child-friendly diagnostic tools and inadequate surveillance and reporting of childhood TB cases.
o Children with TB infection today represent the reservoir of TB disease tomorrow.
o Children are more likely to develop more serious forms of TB such as miliary TB and TB meningitis resulting in high morbidity and mortality.
o Despite policy guidelines, the implementation of contact tracing and delivery of isoniazid preventive therapy (IPT) to young and HIV-infected children is often neglected by public health programmes.
o Most public health programs have limited capacity to meet the demand for care and high-quality services for childhood TB.
o TB care for children is not consistently integrated into HIV and care and maternal and child health programs.
o BCG, the only licenced TB vaccine, has limited efficacy against the most common forms of childhood TB and its effect is of limited duration.
o Due to inadequate case detection it is estimated that a large number of children suffering from TB are not appropriately treated. This is further compounded by drug stock outs and the lack of child-friendly formulations of drugs for TB treatment and prevention.
o Children are rarely included in clinical trials to evaluate new TB drugs, diagnostics or preventive strategies.
To address this current situation, we, the undersigned, call for:
o National TB programmes to include and prioritize childhood TB in their national strategic plans in order to address millennium development goals for children and pregnant women.
o All health care providers to integrate childhood TB into their services.
o The scientific community to include children—of all ages—in clinical and operational studies.
o TB drug and diagnostic product developers to specifically include children in development plans and implementation of research at an early stage.
o Donors to encourage collaboration with researchers, local communities, TB control programmes and other stakeholders to address the growing problem of childhood TB concentrating on:
o Innovative research to develop child-friendly TB diagnostics, drugs, biomarkers and vaccines
o The strengthening of public health facilities and services so that mothers and children with and without HIV can receive appropriate TB care
o Providers of technical assistance to invest in building local technical and programmatic capacity to prevent, diagnose and treat TB in children in all age groups.
o The WHO to accelerate in-country adoption and use of childhood TB guidelines.
o Policy makers to adopt the existing and new WHO recommendations for childhood TB, evaluate implementation, scale-up and assess the impact of implementation strategies.
o Civil society to demand equitable prevention, diagnostics, treatment and care services for childhood TB and to monitor the scale- up of these services.
To ensure that all children exposed to TB or suffering from TB are correctly managed and receive the appropriate treatment, the individuals and institutions signing on to this call to action, pledge to advocate for universal access to prevention, diagnosis and treatment of TB for people of all ages.
We furthermore call on the international community to endorse this call for action to ensure that there is capacity to address the needs of children with TB.
http://www.stoptb.org/
Tuesday, 15 March 2011
TUBERCULOSIS: International meeting on eliminating childhood tuberculosis
11-03-2011
Children suffer severe tuberculosis (TB) related illness that contributes to the overall burden of TB and potentially to overall child mortality. Worldwide, about 1 million TB cases occur each year in children (under 15 years of age) (1).
The latest data from the entire WHO European Region shows that more than 12.6 thousand (8 per 100 000 population) new TB cases occur annually among children. More than 85 % of them were reported by the 18 high priority countries to Stop TB in the Region (3). Rates in those countries were more than six times higher than in the rest of the Region, 14.25 and 2.32 per 100 000 population respectively. However, it is considered that TB in children is underdetected because of the difficulty in diagnosing the disease and/or possible underreporting.
In spite of the overall decline of TB notification rates in the last decade, three thousand children developed TB in the countries of the European Union and European Economic Area in 2010, which remains a marker of transmission in the community, with paediatric cases increasing in the low-burden countries over the past 10 years.
Treatment of TB in children is challenging due to lack of readily available paediatric and child-friendly formulations of anti-TB drugs and difficulty in treating severe forms of TB such as TB meningitis and disseminated TB, as well as multidrug resistant TB and TB and HIV co-infection in children.
While the Bacillus Calmette-Guérin (BCG) vaccination is widely recognized as protecting against severe forms of TB in infants and children, there is less evidence that this protection can be extended to adults. Countries in Europe have large variations in their BCG policies, which are not clearly linked to national TB prevalence. Policies range from no use of BCG at all to vaccination of all children at birth, in infancy, at school entry and in later school years.
To date, considerable efforts on TB have been undertaken in the framework of Millennium Development Goal 6. However, improving children's health is also the prime focus of Millennium Development Goal 4. By acknowledging the fact that TB and other respiratory tract infections seriously impact on the health of children, it is important to work towards the elimination of TB in this vulnerable group to improve childhood health. In collaboration with the Childhood TB Subgroup (DOTS Expansion Working Group (DEWG)-STOP TB Partnership), ECDC is hosting an international meeting on childhood tuberculosis in Stockholm 17 and 18 March 2011 to highlight the challenges and to move the agenda forward in order to achieve a concerted advocacy approach and to hear the voice of children.WHO/Europe is participating in the event as a member of the steering group.
The Regional Director will deliver a video message to the international audience, highlighting children’s health as one of our corporate priorities.
(1) Guidance for national tuberculosis programmes on the management of tuberculosis in children. Geneva, World Health Organization, 2006 (WHO/HTM/TB/2006.371; WHO/FC H/CAH/2006.7).
(2) The 18 high priority countries are: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Republic of Moldova, Romania, Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. WHO Regional Office for Europe. Plan to stop TB in 18 high-priority countries in the European Region, 2007–2015. Copenhagen: 2007
http://www.euro.who.int/en/what-we-do/health-topics/diseases-and-conditions/tuberculosis/news2/news/2011/03/international-meeting-on-eliminating-childhood-tuberculosis
Children suffer severe tuberculosis (TB) related illness that contributes to the overall burden of TB and potentially to overall child mortality. Worldwide, about 1 million TB cases occur each year in children (under 15 years of age) (1).
The latest data from the entire WHO European Region shows that more than 12.6 thousand (8 per 100 000 population) new TB cases occur annually among children. More than 85 % of them were reported by the 18 high priority countries to Stop TB in the Region (3). Rates in those countries were more than six times higher than in the rest of the Region, 14.25 and 2.32 per 100 000 population respectively. However, it is considered that TB in children is underdetected because of the difficulty in diagnosing the disease and/or possible underreporting.
In spite of the overall decline of TB notification rates in the last decade, three thousand children developed TB in the countries of the European Union and European Economic Area in 2010, which remains a marker of transmission in the community, with paediatric cases increasing in the low-burden countries over the past 10 years.
Treatment of TB in children is challenging due to lack of readily available paediatric and child-friendly formulations of anti-TB drugs and difficulty in treating severe forms of TB such as TB meningitis and disseminated TB, as well as multidrug resistant TB and TB and HIV co-infection in children.
While the Bacillus Calmette-Guérin (BCG) vaccination is widely recognized as protecting against severe forms of TB in infants and children, there is less evidence that this protection can be extended to adults. Countries in Europe have large variations in their BCG policies, which are not clearly linked to national TB prevalence. Policies range from no use of BCG at all to vaccination of all children at birth, in infancy, at school entry and in later school years.
To date, considerable efforts on TB have been undertaken in the framework of Millennium Development Goal 6. However, improving children's health is also the prime focus of Millennium Development Goal 4. By acknowledging the fact that TB and other respiratory tract infections seriously impact on the health of children, it is important to work towards the elimination of TB in this vulnerable group to improve childhood health. In collaboration with the Childhood TB Subgroup (DOTS Expansion Working Group (DEWG)-STOP TB Partnership), ECDC is hosting an international meeting on childhood tuberculosis in Stockholm 17 and 18 March 2011 to highlight the challenges and to move the agenda forward in order to achieve a concerted advocacy approach and to hear the voice of children.WHO/Europe is participating in the event as a member of the steering group.
The Regional Director will deliver a video message to the international audience, highlighting children’s health as one of our corporate priorities.
(1) Guidance for national tuberculosis programmes on the management of tuberculosis in children. Geneva, World Health Organization, 2006 (WHO/HTM/TB/2006.371; WHO/FC H/CAH/2006.7).
(2) The 18 high priority countries are: Armenia, Azerbaijan, Belarus, Bulgaria, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Republic of Moldova, Romania, Russian Federation, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. WHO Regional Office for Europe. Plan to stop TB in 18 high-priority countries in the European Region, 2007–2015. Copenhagen: 2007
http://www.euro.who.int/en/what-we-do/health-topics/diseases-and-conditions/tuberculosis/news2/news/2011/03/international-meeting-on-eliminating-childhood-tuberculosis
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