Child TB: global and regional update
Ninth TAG meeting and NTP Managers Meeting9-12th December 2014
Manila
Steve GrahamCentre for International Child Health, University of Melbourne
International Union Against Tuberculosis and Lung Disease(The Union)
Child TB sub-group, Stop TB Partnership
The Meeting on the Development of Child Tuberculosis Action Plans in the Western Pacific Region: HCMC, Viet Nam, March 2014
The objectives of the meeting were:•To share country experiences, lessons learnt and best practices;•To establish priorities and design activities for strengthening childhood TB initiatives in the Western Pacific Region; and•To form a task force to oversee the activities and progress.
The meeting was attended by 21 country participants from 8 countries (Cambodia, China, Fiji, Lao PDR, Mongolia, PNG, Philippines and Viet Nam). Each country team was composed of focal point from NTP, maternal and child health programme and paediatric association.
Also 17 observers participated the meeting from different technical agencies.
Priorities for strengthening childhood TB activities in the WPR
1. Improved political commitment and collaboration with different stakeholders (e.g. MCH, EPI; partners like UNICEF, World Vision; paediatric associations, private providers)2. Improved case detection3. Improved case management and logistical management4. Improved prevention (BCG, IPT, infection control)5. Improved recording, reporting and data analysis (including private sector)6. Improved awareness of community and capacity building of health care worker 7. Operational research
Formation of a Regional Child TB Task Force
Participants of the Meeting formed an informal taskforce called 'The Regional Childhood TB Taskforce' on the Development of Child TB Action Plans in the Western Pacific Region The Regional Childhood TB Taskforce will support members to finalise national action plans and convene a regional workshop (with partners).
•Chair: Steve Graham•Co-Chair: Dr James Amini (PNG); Dr Nguyen Thein Huong (Viet Nam)•Vice Chair: Dr Celine Garfin (Philippines); Dr Lin Zhou (China)•Members: All participants of the meeting•Secretariat: WPRO,WHO
Next meeting: Union APR conference, Sydney, August 2015
Objectives and activities of the taskforce
1. Increase awareness of the child TB disease burden in the Asia-Pacific region
2. Assist the development of pragmatic, contextualized national child TB action plans
3. Monitor & support implementation of these plans
4. Provide an education resource (training)
5. Facilitate collaboration/integration between programs for TB and maternal and child health
Child TB at the new millenium
Childhood tuberculosis: out of control? Donald PR. Curr Opin Pulm Med 2002
JR Starke
Putting child TB on the global public health agenda Child TB subgroup of Stop TB Partnership formed 2003
Children recognised as a vulnerable group in need of increased case-finding: 2009
International Child TB Meeting, Stockholm, 2011
Increasing recognition that TB is an increasingly important cause of morbidity and mortality in infants and young children globally
Pregnancy-related TB – maternal and infant outcomes
Orphans due to TB – estimated to be around 9 million globally
Catastrophic economic costs of TB – families living with TB
TB in adolescents – uncertain burden and specific management issues
TB in the context of maternal and child health
“Know your epidemic”
TB in women – best estimate3,300,000 casesDeaths:330,000 HIV negative180,000 HIV positive
TB in children (0-14 yrs) actual reported 275,00015% smear-positive 54% smear-negative31% EPTB
Best estimates:550,000 cases and 80,000 deaths
Hiatt T & Nishikori N. WPSAR 2014
Age and sex-specific notification rates of new smear-positive TB cases for the Western Pacific Region, 2012
Hiatt T & Nishikori N. WPSAR 2014
Age and sex-specific notification rates of new smear-positive TB cases for the Western Pacific Region, 2012
Risk of TB disease following infection by age
Adapted from Marais B, et al. Int J Tuberc Lung Dis 2004
Gap in surveillance
TB case notifications
known to the NTP
Under-reported
Under-diagnosed
Incident (new) TB cases
Gap
Poor recording and reporting
TB case notifications
known to the NTP
Under-reported
Under-diagnosed
Incident (new) TB cases
Gap
From under-diagnosis
TB case notifications
known to the NTP
Under-reported
Under-diagnosed
Incident (new) TB cases
Gap
to over-diagnosis
TB case notificationsknown to the NTP
Under-reported
Under-diagnosed
Incident (new) TB cases
Not TB cases
Diagnosis of child TB in Java and level of care
TB cases Inpatient Outpatient Overall
Total TB cases 5,877 15,694 21,571
Child TB cases N=648 N=4173 N=4821
% of total burden 11% 27% 22%
< 5 years 56% 53% 53%
Smear positive disease 16% 8% 9%
EPTB 15% 6% 8%
Non-teaching hospital 73% 76% 75%
Private health facility 8% 7% 7%
Lestari T, et al. BMC Pub Health 2011
Burden of child TB in four provinces of PNG: 2005-6
Law I, et al. Poster – The Union Global Lung Health Conference 2008
Pulmonary TB
Smear positiveSmear negativeSmear not done
1208 (61%)
18 (1%)138 (7%)
1052 (53%)EPTB 769 (39%)
Total 1977
Child TB accounts for 30% of total TB burden
Pattern of EPTB disease in children in four provinces of PNG: 2005-6
EPTB cases N=1097
Lymphadenitis
Meningitis
Abdominal
Pleural effusion
Miliary
Spinal
Pericarditis
Bone disease
Not indicated/others
342 (31%)
257 (23%)
173 (16%)
94 (9%)
64 (6%)
41 (4%)
12 (1%)
15 (1%)
99 (9%)
EPTB represented 39% of childhood TB cases
Rapid development of diagnostics
HistoryTuberculinSkin Test
1890
Chest X-ray
1896
Bacteriology
1882
Diagnostic yield for pulmonary TB comparing children to adults
Xpert cannot be used to rule out TB
Xpert needs research on implementation to inform optimal usage in children
South America
BrazilPeru
South Pacific
New CaledoniaCook IslandsTongaMarshall IslandsFederated States of MicronesiaSolomon IslandsVanuataFiji
Union – MSF Operational Research CoursesTOTAL: 212 participants
Community contact screening in Viet NamOct 2012-Dec 2013
Child contacts screened 4109
Eligible for IPT 1577
Numbers received IPT 979 (62%)
% completed to date 88% (n=153)
Children diagnosed with TB 345
Sputum smear positive 37 (11%)
Sputum smear negative PTB 157 (46%)
EPTB 151 (43%)
NATIONAL PLAN FOR THE MANAGEMENT OF TB
IN CHILDREN: 2015-2020
Goal: To strengthen detection, treatment and preventive therapy for Vietnamese children towards decreasing childhood TB morbidity and mortality in Vietnam.
Regional activities in 2014
• WHO WPRO, Regional taskforce, Viet Nam, March
• China National Child TB, Beijing, August
• Global consultation on child TB for high burden countries in EMRO, SEARO and WPRO, Indonesia, September
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