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Guidance for National Tuberculosis Programmes on the management of tuberculosis in children

About one million children develop tuberculosis (TB) annually worldwide, accounting for about 11% of all TB cases. Children with TB differ from adults in their immunological and pathophysiological response in ways that may have important implications for the prevention, diagnosis and treatment of TB in children. There is an urgent need to improve the diagnosis and management of children with TB, and the prevention of TB in children, by ensuring their inclusion under the implementation of the Stop TB strategy by National TB Programmes. Critical areas for further research include a better understanding of the epidemiology of childhood TB, vaccine development, the development of better diagnostic techniques, new drug development, and the optimal. | INT J TUBERC LUNG DIS 10 10 1091-1097 2006 The Union OFFICIAL STATEMENT Guidance for National Tuberculosis Programmes on the management of tuberculosis in children CHAPTER 1 IN THE SERIES Chapter 1 Introduction and diagnosis of tuberculosis in children Stop TB Partnership Childhood TB Subgroup World Health Organization Geneva Switzerland About one million children develop tuberculosis TB annually worldwide accounting for about 11 of all TB cases. Children with TB differ from adults in their immunological and pathophysiological response in ways that may have important implications for the prevention diagnosis and treatment of TB in children. There is an urgent need to improve the diagnosis and management of children with TB and the prevention of TB in children by ensuring their inclusion under the implementation of the Stop TB strategy by National TB Programmes. Critical areas for further research include a better understanding of the epidemiology of childhood TB vaccine development the development of better diagnostic techniques new drug development and the optimal formulations and dosing of first- and second-line TB drugs in children. SUMMARY Specifically regarding the diagnosis of TB in children this relies on a careful and thorough assessment of all the evidence derived from a careful history clinical examination and relevant investigations e.g. tuberculin skin test chest radiograph and sputum smear microscopy. Although bacteriological confirmation of TB is not always possible it should be sought whenever possible e.g. by sputum microscopy in children with suspected pulmonary TB who are old enough to produce a sputum sample. A trial of treatment with TB medications is not generally recommended as a method to diagnose TB in children. New improved diagnostic tests are urgently needed. KEY WORDS tuberculosis children diagnosis IT IS ESTIMATED that one third of the world s population is infected with Mycobacterium tuberculosis the .