Case detection is a crucial step in the cascade of care for children with TB; however, for most children who die from TB, the disease is never diagnosed (80). Children and adolescents who are younger than 15 years represented approximately 12% of incident cases but 16% of the estimated 1.4 million deaths from TB in 2019 (1). This relatively higher share of mortality in children highlights the urgent need for improved case detection and subsequent access to preventive and curative treatment in this age group, particularly for those at highest risk.
These recommendations relate to the two subpopulations of children for whom TB screening is strongly recommended but for whom there is as yet no standard screening approach: children and adolescents younger than 15 years who are close contacts of individuals with TB, and children younger than 10 years who are living with HIV. Adolescents living with HIV who are aged 10–19 years are covered in previous recommendations for screening people living with HIV (see Recommendations 11–15), and screening of contacts 15 years of age and older is covered in the previous recommendation on screening tools (see Recommendations 9–10).
Data from a systematic review of the diagnostic accuracy of multiple screening tools used to detect TB disease among children and adolescents, which were compared against a microbiological or composite reference standard, were used to inform this recommendation. Because bacteriological testing for TB is difficult in children, a composite reference standard is often used when evaluating diagnostic accuracy in this age group.