Overview of Paediatric TB
Paediatric tuberculosis (TB) refers to tuberculosis infections in children. While TB is often thought of as an adult disease, it is a significant cause of illness and death in children, especially in areas with high TB burden. The disease can manifest in various ways, including pulmonary TB (affecting the lungs) and extrapulmonary TB (affecting other organs).
- 38% Increase: The number of notified paediatric TB cases in India has risen by 38% over the past five years, from 102,090 cases in 2020 to 141,182 cases in 2024.
- Age Group Focus: This rise refers to children aged up to 14 years, as defined by the World Health Organization (WHO).
Contributing Factors to the Surge
- Malnutrition:
- High rates of malnutrition are a key contributor to the increased vulnerability of children to TB. Undernourished children have weakened immune systems, making them more susceptible to infection.
- Impact of COVID-19:
- Pandemic Effects: The COVID-19 pandemic indirectly contributed to the rise in TB cases due to weakened immune systems caused by widespread use of steroid treatments. This can reactivate latent TB infections, even in children who had been infected earlier.
- Drug-Resistant TB:
- Multidrug-Resistant TB (MDR-TB) and Extremely Drug-Resistant TB (XDR-TB) cases have been increasingly noted among children. These strains complicate treatment and early diagnosis, exacerbating the burden of paediatric TB.
- Transmission from Adults:
- Children are often infected through adult family members who carry the disease, contributing to a higher rate of transmission in households with active TB cases.
- Underreporting and Diagnostic Challenges:
- Underreporting remains a critical issue, as the actual number of paediatric TB cases is likely higher than the reported figures. Difficulties in diagnosis such as challenges with sputum sample collection and the non-specific presentation of TB in children, particularly extrapulmonary TB, contribute to underreporting.
- Extrapulmonary TB affects areas like lymph nodes and other organs, leading to delayed detection.
Challenges in Reporting and Diagnosis
- Paediatric TB’s Hidden Burden: According to WHO and India’s National TB Elimination Programme (NTEP) estimates, children under 15 account for 10-12% of India’s overall TB burden, translating to around 300,000–350,000 cases annually.
- Diagnostic Difficulties: While the NTEP reports that 5-7% of all TB cases annually are in children, the actual incidence of paediatric TB is expected to be higher. The gap between expected and reported cases can be attributed to:
- Difficulties in sputum sample collection for young children.
- Nonspecific symptoms in children, which often leads to delayed diagnosis, particularly in cases of extrapulmonary TB.
Current Government Actions and Strategy
- National Strategic Plan: The government is promoting early diagnosis and prompt treatment of TB in children under the National Strategic Plan for the Elimination of TB in India.
- The goal is to improve the availability of quality-assured TB drugs and regimens to ensure effective treatment for children suffering from TB.
- The focus is on enhancing surveillance and diagnostic capabilities to reduce the underreporting of cases.
Future Considerations
- Strengthening Diagnosis and Surveillance:
- Addressing the diagnostic gap and ensuring timely detection will be critical in controlling the spread of paediatric TB.
- Efforts to improve sputum collection methods and develop specific diagnostic tools for children are essential to enhance reporting accuracy.
- Nutritional and Healthcare Support:
- Malnutrition is a significant risk factor for TB. Improving nutritional support for children, especially in underserved regions, is key to reducing TB vulnerability.
- Multidrug-Resistant TB:
- The rising incidence of drug-resistant TB necessitates the development of specialized treatment regimens for children, alongside increased access to second-line TB drugs.
The increasing incidence of paediatric TB in India points to multiple interconnected factors, including malnutrition, the COVID-19 impact, and drug resistance. While diagnostic advancements have led to higher reported cases, there are still significant challenges in early detection and underreporting.
