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Recent Advances and Ongoing Challenges in the Management of Tuberculosis...
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Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents

A special issue of Pathogens (ISSN 2076-0817). This special issue belongs to the section "Bacterial Pathogens".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 80616

Special Issue Editors

Prof. Dr. Steve M Graham

E-Mail Website
Guest Editor
Centre for International Child Health and Burnet Institute, University of Melbourne, Melbourne, Australia
Interests: tuberculosis; implementation research; child health; adolescent tuberculosis; prevention; diagnosis; treatment; drug-resistant
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Ben J. Marais

E-Mail Website
Guest Editor
Institute for Infectious Diseases and the Centre for Research Excellence in Tuberculosis, The University of Sydney, Sydney, Australia
Interests: tuberculosis, infectious diseases, child, paediatric
Dr. Farhana Amanullah

E-Mail Website
Guest Editor
The Indus Hospital & Health Network and the Aga Khan University, Karachi, Pakistan
Interests: Childhood TB

Special Issue Information

Dear Colleagues,

Tuberculosis is a major cause of morbidity and mortality in children and adolescents globally. Almost all cases occur in resource-limited settings and there are major, ongoing gaps in the detection, treatment, and prevention of tuberculosis in this vulnerable population. Updated policy guidelines and recommendations are currently under development by the World Health Organization, as well as an accompanying operational handbook. These updated guidelines are critical to help to close persistent policy–practice gaps, and there is unprecedented opportunity to achieve this, but every effort should be made to raise awareness and coordinate global action.

A Special Issue of Pathogens is proposed for publication to coincide with World TB Day in March 2022. This issue with include concise, peer-reviewed “state-of-the-art” articles by recognized leaders in child tuberculosis research and clinical management, as well as perspectives on challenges for programmatic implementation in “real life” settings. The articles will address a wide range of issues that include epidemiology, clinical care, prevention, and health systems strengthening for drug-susceptible and drug-resistant tuberculosis in children and adolescents.

Prof. Dr. Steve M Graham
Prof. Dr. Ben J. Marais
Dr. Farhana Amanullah
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pathogens is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • tuberculosis
  • infant
  • child
  • adolescent
  • diagnosis
  • treatment
  • prevention

Published Papers (16 papers)

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Editorial

Jump to: Review, Other

4 pages, 196 KiB  
Editorial
Tuberculosis in Children and Adolescents: Progress and Perseverance
by Stephen M. Graham, Ben J. Marais and Farhana Amanullah
Pathogens 2022, 11(4), 392; https://doi.org/10.3390/pathogens11040392 - 24 Mar 2022
Cited by 3 | Viewed by 2381
Abstract
Although it is an ancient pathogen, tuberculosis (TB) remains a major infectious cause of death globally, transiently displaced by COVID-19 [...] Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)

Review

Jump to: Editorial, Other

19 pages, 321 KiB  
Review
Diagnostic Advances in Childhood Tuberculosis—Improving Specimen Collection and Yield of Microbiological Diagnosis for Intrathoracic Tuberculosis
by Eric Wobudeya, Maryline Bonnet, Elisabetta Ghimenton Walters, Pamela Nabeta, Rinn Song, Wilfred Murithi, Walter Mchembere, Bunnet Dim, Jean-Voisin Taguebue, Joanna Orne-Gliemann, Mark P. Nicol and Olivier Marcy
Pathogens 2022, 11(4), 389; https://doi.org/10.3390/pathogens11040389 - 23 Mar 2022
Cited by 13 | Viewed by 3805
Abstract
There is no microbiological gold standard for childhood tuberculosis (TB) diagnosis. The paucibacillary nature of the disease, challenges in sample collection in young children, and the limitations of currently available microbiological tests restrict microbiological confirmation of intrathoracic TB to the minority of children. [...] Read more.
There is no microbiological gold standard for childhood tuberculosis (TB) diagnosis. The paucibacillary nature of the disease, challenges in sample collection in young children, and the limitations of currently available microbiological tests restrict microbiological confirmation of intrathoracic TB to the minority of children. Recent WHO guidelines recommend the use of novel rapid molecular assays as initial diagnostic tests for TB and endorse alternative sample collection methods for children. However, the uptake of these tools in high-endemic settings remains low. In this review, we appraise historic and new microbiological tests and sample collection techniques that can be used for the diagnosis of intrathoracic TB in children. We explore challenges and possible ways to improve diagnostic yield despite limitations, and identify research gaps to address in order to improve the microbiological diagnosis of intrathoracic TB in children. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
11 pages, 1311 KiB  
Review
Diagnostic Challenges in Childhood Pulmonary Tuberculosis—Optimizing the Clinical Approach
by Kenneth S. Gunasekera, Bryan Vonasek, Jacquie Oliwa, Rina Triasih, Christina Lancioni, Stephen M. Graham, James A. Seddon and Ben J. Marais
Pathogens 2022, 11(4), 382; https://doi.org/10.3390/pathogens11040382 - 23 Mar 2022
Cited by 7 | Viewed by 5304
Abstract
The management of childhood tuberculosis (TB) is hampered by the low sensitivity and limited accessibility of microbiological testing. Optimizing clinical approaches is therefore critical to close the persistent gaps in TB case detection and prevention necessary to realize the child mortality targets of [...] Read more.
The management of childhood tuberculosis (TB) is hampered by the low sensitivity and limited accessibility of microbiological testing. Optimizing clinical approaches is therefore critical to close the persistent gaps in TB case detection and prevention necessary to realize the child mortality targets of the End TB Strategy. In this review, we provide practical guidance summarizing the evidence and guidelines describing the use of symptoms and signs in decision making for children being evaluated for either TB preventive treatment (TPT) or TB disease treatment in high-TB incidence settings. Among at-risk children being evaluated for TPT, a symptom screen may be used to differentiate children who require further investigation for TB disease before receiving TPT. For symptomatic children being investigated for TB disease, an algorithmic approach can inform which children should receive TB treatment, even in the absence of imaging or microbiological confirmation. Though clinical approaches have limitations in accuracy, they are readily available and can provide valuable guidance for decision making in resource-limited settings to increase treatment access. We discuss the trade-offs in using them to make TB treatment decisions. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
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12 pages, 267 KiB  
Review
Treatment of Rifampicin-Resistant Tuberculosis Disease and Infection in Children: Key Updates, Challenges and Opportunities
by Pauline Howell, Jay Achar, G. Khai Lin Huang, Andrei Mariandyshev, H. Simon Schaaf and Anthony J. Garcia-Prats
Pathogens 2022, 11(4), 381; https://doi.org/10.3390/pathogens11040381 - 23 Mar 2022
Cited by 12 | Viewed by 3010
Abstract
Children affected by rifampicin-resistant tuberculosis (RR-TB; TB resistant to at least rifampicin) are a neglected group. Each year an estimated 25,000–30,000 children develop RR-TB disease globally. Improving case detection and treatment initiation is a priority since RR-TB disease is underdiagnosed and undertreated. Untreated [...] Read more.
Children affected by rifampicin-resistant tuberculosis (RR-TB; TB resistant to at least rifampicin) are a neglected group. Each year an estimated 25,000–30,000 children develop RR-TB disease globally. Improving case detection and treatment initiation is a priority since RR-TB disease is underdiagnosed and undertreated. Untreated paediatric TB has particularly high morbidity and mortality. However, children receiving TB treatment, including for RR-TB, respond well. RR-TB treatment remains a challenge for children, their caregivers and TB programmes, requiring treatment regimens of up to 18 months in duration, often associated with severe and long-term adverse effects. Shorter, safer, effective child-friendly regimens for RR-TB are needed. Preventing progression to disease following Mycobacterium tuberculosis infection is another key component of TB control. The last few years have seen exciting advances. In this article, we highlight key elements of paediatric RR-TB case detection and recent updates, ongoing challenges and forthcoming advances in the treatment of RR-TB disease and infection in children and adolescents. The global TB community must continue to advocate for more and faster research in children on novel and repurposed TB drugs and regimens and increase investments in scaling-up effective approaches, to ensure an equitable response that prioritises the needs of this vulnerable population. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
11 pages, 2042 KiB  
Review
Addressing the Data Gaps on Child and Adolescent Tuberculosis
by Sabine Verkuijl, Moorine Penninah Sekadde, Peter J. Dodd, Moses Arinaitwe, Silvia S. Chiang, Annemieke Brands, Kerri Viney, Charalambos Sismanidis and Helen E. Jenkins
Pathogens 2022, 11(3), 352; https://doi.org/10.3390/pathogens11030352 - 14 Mar 2022
Cited by 6 | Viewed by 2957
Abstract
The burden of tuberculosis (TB) among children and young adolescents (<15 years old) is estimated at 1.1 million; however, only 400,000 are treated for TB, indicating a large gap between the number who are cared for and the number estimated to have TB. [...] Read more.
The burden of tuberculosis (TB) among children and young adolescents (<15 years old) is estimated at 1.1 million; however, only 400,000 are treated for TB, indicating a large gap between the number who are cared for and the number estimated to have TB. Accurate data on the burden of pediatric TB is essential to guide action. Despite several improvements in estimating the burden of pediatric TB in the last decade, as well as enhanced data collection efforts, several data gaps remain, both at the global level, but also at the national level where surveillance systems and collaborative research are critical. In this article, we describe recent advances in data collection and burden estimates for TB among children and adolescents, and the remaining gaps. While data collection continues to improve, burden estimates must evolve in parallel, both in terms of their frequency and the methods used. Currently, at the global level, there is a focus on age-disaggregation of TB notifications, the collection of data on TB-HIV, multi-drug resistant (MDR)-TB and treatment outcomes, as well as estimates of the disease burden. Additional data from national surveillance systems or research projects on TB meningitis, as well as other forms of extra-pulmonary TB, would be useful. We must capitalize on the current momentum in child and adolescent TB to close the remaining data gaps for these age groups to better understand the epidemic and further reduce morbidity and mortality due to TB. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
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17 pages, 896 KiB  
Review
Towards Accurate Point-of-Care Tests for Tuberculosis in Children
by Nina Vaezipour, Nora Fritschi, Noé Brasier, Sabine Bélard, José Domínguez, Marc Tebruegge, Damien Portevin and Nicole Ritz
Pathogens 2022, 11(3), 327; https://doi.org/10.3390/pathogens11030327 - 08 Mar 2022
Cited by 10 | Viewed by 8484
Abstract
In childhood tuberculosis (TB), with an estimated 69% of missed cases in children under 5 years of age, the case detection gap is larger than in other age groups, mainly due to its paucibacillary nature and children’s difficulties in delivering sputum specimens. Accurate [...] Read more.
In childhood tuberculosis (TB), with an estimated 69% of missed cases in children under 5 years of age, the case detection gap is larger than in other age groups, mainly due to its paucibacillary nature and children’s difficulties in delivering sputum specimens. Accurate and accessible point-of-care tests (POCTs) are needed to detect TB disease in children and, in turn, reduce TB-related morbidity and mortality in this vulnerable population. In recent years, several POCTs for TB have been developed. These include new tools to improve the detection of TB in respiratory and gastric samples, such as molecular detection of Mycobacterium tuberculosis using loop-mediated isothermal amplification (LAMP) and portable polymerase chain reaction (PCR)-based GeneXpert. In addition, the urine-based detection of lipoarabinomannan (LAM), as well as imaging modalities through point-of-care ultrasonography (POCUS), are currently the POCTs in use. Further to this, artificial intelligence-based interpretation of ultrasound imaging and radiography is now integrated into computer-aided detection products. In the future, portable radiography may become more widely available, and robotics-supported ultrasound imaging is currently being trialed. Finally, novel blood-based tests evaluating the immune response using “omic-“techniques are underway. This approach, including transcriptomics, metabolomic, proteomics, lipidomics and genomics, is still distant from being translated into POCT formats, but the digital development may rapidly enhance innovation in this field. Despite these significant advances, TB-POCT development and implementation remains challenged by the lack of standard ways to access non-sputum-based samples, the need to differentiate TB infection from disease and to gain acceptance for novel testing strategies specific to the conditions and settings of use. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
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15 pages, 3146 KiB  
Review
Chest Imaging for Pulmonary TB—An Update
by Michael Nel, Zoe Franckling-Smith, Tanyia Pillay, Savvas Andronikou and Heather J. Zar
Pathogens 2022, 11(2), 161; https://doi.org/10.3390/pathogens11020161 - 26 Jan 2022
Cited by 14 | Viewed by 19026
Abstract
The diagnosis of pulmonary tuberculosis (PTB) in children is challenging. Difficulties in acquiring suitable specimens, pauci-bacillary load, and limitations of current diagnostic methods often make microbiological confirmation difficult. Chest imaging provides an additional diagnostic modality that is frequently used in clinical practice. Chest [...] Read more.
The diagnosis of pulmonary tuberculosis (PTB) in children is challenging. Difficulties in acquiring suitable specimens, pauci-bacillary load, and limitations of current diagnostic methods often make microbiological confirmation difficult. Chest imaging provides an additional diagnostic modality that is frequently used in clinical practice. Chest imaging can also provide insight into treatment response and identify development of disease complications. Despite widespread use, chest radiographs are usually non-specific and have high inter- and intra-observer variability. Other diagnostic imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can provide additional information to substantiate diagnosis. In this review, we discuss the radiological features of PTB in each modality, highlighting the advantages and limitations of each. We also address newer imaging technologies and potential use. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
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15 pages, 2688 KiB  
Review
Tuberculous Meningitis in Children: Reducing the Burden of Death and Disability
by Julie Huynh, Yara-Natalie Abo, Karen du Preez, Regan Solomons, Kelly E Dooley and James A Seddon
Pathogens 2022, 11(1), 38; https://doi.org/10.3390/pathogens11010038 - 30 Dec 2021
Cited by 19 | Viewed by 6357
Abstract
Tuberculous meningitis disproportionately affects young children. As the most devastating form of tuberculosis, it is associated with unacceptably high rates of mortality and morbidity even if treated. Challenging to diagnose and treat, tuberculous meningitis commonly causes long-term neurodisability in those who do survive. [...] Read more.
Tuberculous meningitis disproportionately affects young children. As the most devastating form of tuberculosis, it is associated with unacceptably high rates of mortality and morbidity even if treated. Challenging to diagnose and treat, tuberculous meningitis commonly causes long-term neurodisability in those who do survive. There remains an urgent need for strengthened surveillance, improved rapid diagnostics technology, optimised anti-tuberculosis drug therapy, investigation of new host-directed therapy, and further research on long-term functional and neurodevelopmental outcomes to allow targeted intervention. This review focuses on the neglected field of paediatric tuberculous meningitis and bridges current clinical gaps with research questions to improve outcomes from this crippling disease. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
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12 pages, 395 KiB  
Review
HIV-Associated Tuberculosis in Children and Adolescents: Evolving Epidemiology, Screening, Prevention and Management Strategies
by Alexander W. Kay, Helena Rabie, Elizabeth Maleche-Obimbo, Moorine Penninah Sekadde, Mark F. Cotton and Anna M. Mandalakas
Pathogens 2022, 11(1), 33; https://doi.org/10.3390/pathogens11010033 - 29 Dec 2021
Cited by 8 | Viewed by 2365
Abstract
Children and adolescents living with HIV continue to be impacted disproportionately by tuberculosis as compared to peers without HIV. HIV can impact TB screening and diagnosis by altering screening and diagnostic test performance and can complicate prevention and treatment strategies due to drug–drug [...] Read more.
Children and adolescents living with HIV continue to be impacted disproportionately by tuberculosis as compared to peers without HIV. HIV can impact TB screening and diagnosis by altering screening and diagnostic test performance and can complicate prevention and treatment strategies due to drug–drug interactions. Post-tuberculosis lung disease is an underappreciated phenomenon in children and adolescents, but is more commonly observed in children and adolescents with HIV-associated tuberculosis. This review presents new data related to HIV-associated TB in children and adolescents. Data on the epidemiology of HIV-associated TB suggests that an elevated risk of TB in children and adolescents with HIV persists even with broad implementation of ART. Recent guidance also indicates the need for new screening strategies for HIV-associated TB. There have been major advances in the availability of new antiretroviral medications and also TB prevention options for children, but these advances have come with additional questions surrounding drug–drug interactions and dosing in younger age groups. Finally, we review new approaches to manage post-TB lung disease in children living with HIV. Collectively, we present data on the rapidly evolving field of HIV-associated child tuberculosis. This evolution offers new management opportunities for children and adolescents living with HIV while also generating new questions for additional research. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
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15 pages, 276 KiB  
Review
Child Contact Case Management—A Major Policy-Practice Gap in High-Burden Countries
by Anca Vasiliu, Nicole Salazar-Austin, Anete Trajman, Trisasi Lestari, Godwin Mtetwa, Maryline Bonnet and Martina Casenghi
Pathogens 2022, 11(1), 1; https://doi.org/10.3390/pathogens11010001 - 21 Dec 2021
Cited by 8 | Viewed by 2696
Abstract
The 2021 Global Tuberculosis (TB) report shows slow progress towards closing the pediatric TB detection gap and improving the TB preventive treatment (TPT) coverage among child and adolescent contacts. This review presents the current knowledge around contact case management (CCM) in low-resource settings, [...] Read more.
The 2021 Global Tuberculosis (TB) report shows slow progress towards closing the pediatric TB detection gap and improving the TB preventive treatment (TPT) coverage among child and adolescent contacts. This review presents the current knowledge around contact case management (CCM) in low-resource settings, with a focus on child contacts, which represents a key priority population for CCM and TPT. Compelling evidence demonstrates that CCM interventions are a key gateway for both TB case finding and identification of those in need of TPT, and their yield and effectiveness should provide a strong rationale for prioritization by national TB programs. A growing body of evidence is now showing that innovative models of care focused on community-based and patient-centered approaches to household contact investigation can help narrow down the CCM implementation gaps that we are currently facing. The availability of shorter and child-friendly TPT regimens for child contacts provide an additional important opportunity to improve TPT acceptability and adherence. Prioritization of TB CCM implementation and adequate resource mobilization by ministries of health, donors and implementing agencies is needed to timely close the gap. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
17 pages, 329 KiB  
Review
The Impact of Tuberculosis on the Well-Being of Adolescents and Young Adults
by Patricia Moscibrodzki, Leslie A. Enane, Graeme Hoddinott, Meredith B. Brooks, Virginia Byron, Jennifer Furin, James A. Seddon, Lily Meyersohn and Silvia S. Chiang
Pathogens 2021, 10(12), 1591; https://doi.org/10.3390/pathogens10121591 - 08 Dec 2021
Cited by 17 | Viewed by 4141
Abstract
The health needs of adolescents and young adults (AYAs) have been neglected in tuberculosis (TB) care, control, and research. AYAs, who are distinct from younger children and older adults, undergo dynamic physical, psychological, emotional, cognitive, and social development. Five domains of adolescent well-being [...] Read more.
The health needs of adolescents and young adults (AYAs) have been neglected in tuberculosis (TB) care, control, and research. AYAs, who are distinct from younger children and older adults, undergo dynamic physical, psychological, emotional, cognitive, and social development. Five domains of adolescent well-being are crucial to a successful transition between childhood and adulthood: (1) Good health; (2) connectedness and contribution to society; (3) safety and a supportive environment; (4) learning, competence, education, skills, and employability; and (5) agency and resilience. This review summarizes the evidence of the impact of TB disease and treatment on these five domains of AYA well-being. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
8 pages, 233 KiB  
Review
Provision of Decentralized TB Care Services: A Detect–Treat–Prevent Strategy for Children and Adolescents Affected by TB
by Stella Zawedde-Muyanja, Anja Reuter, Marco A. Tovar, Hamidah Hussain, Aime Loando Mboyo, Anne K. Detjen and Courtney M. Yuen
Pathogens 2021, 10(12), 1568; https://doi.org/10.3390/pathogens10121568 - 01 Dec 2021
Cited by 10 | Viewed by 3206
Abstract
In this review, we discuss considerations and successful models for providing decentralized diagnosis, treatment, and prevention services for children and adolescents. Key approaches to building decentralized capacity for childhood TB diagnosis in primary care facilities include provider training and increased access to child-focused [...] Read more.
In this review, we discuss considerations and successful models for providing decentralized diagnosis, treatment, and prevention services for children and adolescents. Key approaches to building decentralized capacity for childhood TB diagnosis in primary care facilities include provider training and increased access to child-focused diagnostic tools and techniques. Treatment of TB disease should be managed close to where patients live; pediatric formulations of both first- and second-line drugs should be widely available; and any hospitalization should be for as brief a period as medically indicated. TB preventive treatment for child and adolescent contacts must be greatly expanded, which will require home visits to identify contacts, building capacity to rule out TB, and adoption of shorter preventive regimens. Decentralization of TB services should involve the private sector, with collaborations outside the TB program in order to reach children and adolescents where they first enter the health care system. The impact of decentralization will be maximized if programs are family-centered and designed around responding to the needs of children and adolescents affected by TB, as well as their families. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)

Other

Jump to: Editorial, Review

14 pages, 955 KiB  
Perspective
Evidence to Action: Translating Innovations in Management of Child and Adolescent TB into Routine Practice in High-Burden Countries
by Brittany K. Moore, Riitta A. Dlodlo, John Paul Dongo, Sabine Verkuijl, Moorine P. Sekadde, Charles Sandy and Susan A. Maloney
Pathogens 2022, 11(4), 383; https://doi.org/10.3390/pathogens11040383 - 23 Mar 2022
Cited by 3 | Viewed by 2290
Abstract
Child and adolescent tuberculosis (TB) has been long neglected by TB programs but there have been substantive strides in prioritizing TB among these populations in the past two decades. Yet, gaps remain in translating evidence and policy to action at the primary care [...] Read more.
Child and adolescent tuberculosis (TB) has been long neglected by TB programs but there have been substantive strides in prioritizing TB among these populations in the past two decades. Yet, gaps remain in translating evidence and policy to action at the primary care level, ensuring access to novel tools and approaches to diagnosis, treatment, and prevention for children and adolescents at risk of TB disease. This article describes the progress that has been made and the gaps that remain in addressing TB among children and adolescents while also highlighting pragmatic approaches and the role of multisectoral partnerships in facilitating integration of innovations into routine program practice. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
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26 pages, 1408 KiB  
Perspective
Priority Activities in Child and Adolescent Tuberculosis to Close the Policy-Practice Gap in Low- and Middle-Income Countries
by Karen du Preez, Betina Mendez Alcântara Gabardo, Sushil K. Kabra, Rina Triasih, Trisasi Lestari, Margaret Kal, Bazarragchaa Tsogt, Gantsetseg Dorj, Enkhtsetseg Purev, Thu Anh Nguyen, Lenny Naidoo, Lindiwe Mvusi, Hendrik Simon Schaaf, Anneke C. Hesseling, Andrea Maciel de Oliveira Rossoni, Anna Cristina Calçada Carvalho, Claudete Aparecida Araújo Cardoso, Clemax Couto Sant’Anna, Danielle Gomes Dell’ Orti, Fernanda Dockhorn Costa, Liliana Romero Vega, Maria de Fátima Pombo Sant’Anna, Nguyen Binh Hoa, Phan Huu Phuc, Attannon Arnauld Fiogbe, Dissou Affolabi, Gisèle Badoum, Abdoul Risgou Ouédraogo, Tandaogo Saouadogo, Adjima Combary, Albert Kuate Kuate, Bisso Ngono Annie Prudence, Aboubakar Sidiki Magassouba, Adama Marie Bangoura, Alphazazi Soumana, Georges Hermana, Hervé Gando, Nafissatou Fall, Barnabé Gning, Mohammed Fall Dogo, Olivia Mbitikon, Manon Deffense, Kevin Zimba, Chishala Chabala, Moorine Penninah Sekadde, Henry Luzze, Stavia Turyahabwe, John Paul Dongo, Constantino Lopes, Milena dos Santos, Joshua Reginald Francis, Magnolia Arango-Loboguerrero, Carlos M. Perez-Velez, Kobto Ghislain Koura and Stephen M. Grahamadd Show full author list remove Hide full author list
Pathogens 2022, 11(2), 196; https://doi.org/10.3390/pathogens11020196 - 01 Feb 2022
Cited by 9 | Viewed by 4034
Abstract
Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause [...] Read more.
Over the past 15 years, and despite many difficulties, significant progress has been made to advance child and adolescent tuberculosis (TB) care. Despite increasing availability of safe and effective treatment and prevention options, TB remains a global health priority as a major cause of child and adolescent morbidity and mortality—over one and a half million children and adolescents develop TB each year. A history of the global public health perspective on child and adolescent TB is followed by 12 narratives detailing challenges and progress in 19 TB endemic low and middle-income countries. Overarching challenges include: under-detection and under-reporting of child and adolescent TB; poor implementation and reporting of contact investigation and TB preventive treatment services; the need for health systems strengthening to deliver effective, decentralized services; and lack of integration between TB programs and child health services. The COVID-19 pandemic has had a significant negative impact on case detection and treatment outcomes. Child and adolescent TB working groups can address country-specific challenges to close the policy–practice gaps by developing and supporting decentral ized models of care, strengthening clinical and laboratory diagnosis, including of multidrug-resistant TB, providing recommended options for treatment of disease and infection, and forging strong collaborations across relevant health sectors. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
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16 pages, 288 KiB  
Perspective
Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings
by Jeffrey R. Starke, Connie Erkens, Nicole Ritz and Ian Kitai
Pathogens 2022, 11(2), 158; https://doi.org/10.3390/pathogens11020158 - 26 Jan 2022
Cited by 3 | Viewed by 2345
Abstract
In low tuberculosis-burden countries, children and adolescents with the highest incidence of tuberculosis (TB) infection or disease are usually those who have immigrated from high-burden countries. It is, therefore, essential that low-burden countries provide healthcare services to immigrant and refugee families, to assure [...] Read more.
In low tuberculosis-burden countries, children and adolescents with the highest incidence of tuberculosis (TB) infection or disease are usually those who have immigrated from high-burden countries. It is, therefore, essential that low-burden countries provide healthcare services to immigrant and refugee families, to assure that their children can receive proper testing, evaluation, and treatment for TB. Active case-finding through contact tracing is a critical element of TB prevention in children and in finding TB disease at an early, easily treated stage. Passive case-finding by evaluating an ill child is often delayed, as other, more common infections and conditions are suspected initially. While high-quality laboratory services to detect Mycobacterium tuberculosis are generally available, they are often underutilized in the diagnosis of childhood TB, further delaying diagnosis in some cases. Performing research on TB disease is difficult because of the low number of cases that are spread over many locales, but critical research on the evaluation and treatment of TB infection has been an important legacy of low-burden countries. The continued education of medical providers and the involvement of educational, professional, and non-governmental organizations is a key element of maintaining awareness of the presence of TB. This article provides the perspective from North America and Western Europe but is relevant to many low-endemic settings. TB in children and adolescents will persist in low-burden countries as long as it persists throughout the rest of the world, and these wealthy countries must increase their financial commitment to end TB everywhere. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
13 pages, 262 KiB  
Perspective
Pediatric Tuberculosis Research and Development: Progress, Priorities and Funding Opportunities
by Lindsay McKenna, Ani Herna Sari, Sushant Mane, Anna Scardigli, Grania Brigden, Vanessa Rouzier, Mercedes C. Becerra, Anneke C. Hesseling and Farhana Amanullah
Pathogens 2022, 11(2), 128; https://doi.org/10.3390/pathogens11020128 - 21 Jan 2022
Cited by 11 | Viewed by 3678
Abstract
In this article, we highlight technological pediatric TB research advances across the TB care cascade; discuss recently completed or ongoing work in adults and corresponding significant research gaps for children; and offer recommendations and opportunities to increase investments and accelerate pediatric TB R&D. [...] Read more.
In this article, we highlight technological pediatric TB research advances across the TB care cascade; discuss recently completed or ongoing work in adults and corresponding significant research gaps for children; and offer recommendations and opportunities to increase investments and accelerate pediatric TB R&D. Full article
(This article belongs to the Special Issue Recent Advances and Ongoing Challenges in the Management of Tuberculosis in Children and Adolescents)
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