Children and young adolescents (aged below 15 years) represent about 11% of all people with TB globally. This means that close to 1.1 million children become ill with TB every year, almost half of them below five years of age. National TB programmes (NTPs) only notify less than half of these children, meaning that there is a large case detection gap (1). The reasons for this gap include challenges with specimen collection and bacteriological confirmation of TB in young children, due to the paucibacillary nature of TB disease in this age group and the lack of highly sensitive point-of-care tests (10). In 2020, the COVID-19 pandemic had an additional negative impact on TB notifications in children, with a 24% decrease in notifications compared to 2019 (in comparison, notifications in people aged 15 years and above decreased by 18%). In addition to the case detection gap, only one third of child contacts below five years of age eligible for TB preventive treatment (TPT) actually received it in 2020 (1). Young children are at higher risk of developing TB disease, including severe forms of TB, than older age groups, after TB infection, and the majority do so within a few months following exposure and infection (2, 3). In addition to children and young adolescents, over half a million older adolescents (15-19 years) are estimated to develop TB every year (4).
The United Nations Sustainable Development Goal (SDGs) (5)and the World Health Organization (WHO) End TB Strategy (6) include targets to reduce TB incidence by 80% and TB deaths by 90% to be achieved by the year 2030, relative to baseline levels in 2015. In addition, the Resolution adopted by the United Nations General Assembly (UNGA) at the High-Level Meeting on the fight against tuberculosis in September 2018 commits to diagnosing and treating 40 million people with TB (including 3.5 million children), and 1.5 million people with DR-TB (including 115 000 children) by 2022. It also commits to providing at least 30 million people (including 4 million child contacts under five years of age), 20 million other household contacts (including children over the age of five years) and 6 million people living with HIV (including children) with TPT by 2022 (7).
To support countries in preventing and managing TB in children and adolescents, WHO's Global Tuberculosis Programme published the WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children (second edition) in 2014. Since these guidelines were published, new recommendations and guidance on the management of TB have been published in WHO guidelines and other policy documents on TB prevention, screening, diagnosis, treatment, management and models of care. Many of these recommendations are also applicable to children and adolescents. In addition, new evidence related to the management of TB in children and adolescents became available to WHO in 2021. Some of these data were received in response to a specific request from WHO for data on the management of TB in children and adolescents, issued as an Expression of Interest in July 2020,¹⁷ which was developed in consultation with the core team of the Child and Adolescent TB Working group.¹⁸ Data from a randomized controlled trial on treatment shortening for children with non-severe TB were made available to the WHO in 2021. Therefore, in 2021, the WHO convened a Guideline Development Group (GDG) to review new evidence on the management of TB in children and adolescents. This guideline update includes new recommendations that were issued at the GDG meeting in May-June 2021 as well as current recommendations from other WHO guidelines that are relevant to the management of TB in children and adolescents (including those that are in the previous guidelines on the management of TB in children that have been validated). This update consolidates all recommendations in one guideline.
¹⁷ WHO public call for data on the management of TB in children and adolescents. 24 July 2020. WHO [website] (https://www.who.int/ news-room/articles-detail/who-public-call-for-data-on-the-management-of-tb-in-children-and-adolescents, accessed 20 January 2022).
¹⁸ Child and Adolescent TB Working Group (https://www.stoptb.org/wg/dots_expansion/childhoodtb/, accessed 20 January 2022).