Pediatrics

Children have been neglected in the fight against TB. It is difficult to diagnose TB in children and, as a result, the true burden of drug-sensitive and drug-resistant TB in children across the globe is unknown. While in 2013 the World Health Organization (WHO) estimated that 550,000 children developed TB, researchers from Brigham and Women’s Hospital and Harvard Medical School recently estimated that 1 million children develop TB annually – twice the number estimated by the WHO, and three times the number of children diagnosed each year – and, of those, 32,000 have drug-resistant TB. The perception that children do not transmit TB disease and the perceived small market for TB treatment in children have contributed to global and programmatic neglect of this population. Only recently have children been explicitly included in global and national TB agendas and largely as a result of the work of research and policy groups like the Sentinel Project for Pediatric Drug-Resistant TB, the Stop TB Partnership’s Childhood TB Subgroup, the Tuberculosis Trials Consortium Pediatric Interest Group, the U.S. National Institutes of Health (NIH) International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT), and a new NIH-convened multi-stakeholder panel that is promoting timely pediatric safety and dosing evidence for TB drugs and regimens.

It is estimated that US$200 million between 2011 and 2015 is needed for research and development (R&D) projects to provide new tools to adequately prevent, diagnose, and treat TB in children. Yet, in 2013, Treatment Action Group (TAG) reported only US$25.3 million in pediatric TB R&D investments from 19 donors. While this is more than double the US$10.3 million reported in 2012, at the midpoint of the 2011–2015 period, the world has spent just one-fourth of the targeted US$200 million. Pediatric TB R&D investments follow the larger trend of insufficient TB R&D funding overall described in TAG’s 2014 Report on Tuberculosis Research Funding Trends, 2005–2013.

In order to achieve zero child TB deaths, new infections, stigma, and suffering, we urgently need improved diagnostic tests that are better able to detect TB in children, child-friendly formulations of appropriately dosed first- and second-line TB drugs, and expedited research to better inform the treatment of children with novel and existing TB drugs. Pediatric TB drug needs are outlined in more detail by Polly Clayden in her article for the spring 2013 issue of TAGline, TB Drugs for Children, and in the pediatric TB treatment chapter of Treatment Action Group’s annual Pipeline Report.

Additional resources:

Childhood TB Roadmap: a guiding document resulting from a collaboration between the Stop TB Partnership Childhood TB subgroup, the World Health Organization, the United Nations Children’s Fund, USAID, the International Union Against Tuberculosis and Lung Disease, the Sentinel Project on Pediatric Drug-Resistant Tuberculosis, and TAG. This document seeks to outline the activities that need to be implemented to accelerate progress toward the elimination of childhood TB.

Sentinel Project on Pediatric Drug-Resistant Tuberculosis: a global partnership of more than 250 researchers, caregivers, and advocates from more than 50 countries who share a vision of a world where no child dies from this curable disease. The Sentinel Project have developed several useful resources including:

  • a practical field handbook to guide treatment of MDR-TB in children;
  • a weight-based dosing chart to facilitate appropriate treatment using existing formulations; and
  • two collections of stories of children affected by MDR-TB, which point to gaps in the prevention, diagnosis and treatment of MDR-TB in children.