Digitally colorized scanning electron microscopic (SEM) image, depicts a large group of orange-colored, rod shaped, Mycobacterium tuberculosis bacteria, which cause tuberculosis (TB) in human beings.Credit: NIAID
A new study, published in the New England Journal of Medicine has recommended treatment for children with drug-sensitive tuberculosis be shortened from six to four months. The recommendation, adopted by the World Health Organization (WHO), is projected to reduce the burden of the disease on families and healthcare systems around the world.
Study participants for the first randomized control trial to assess whether children with minimal TB could be effectively treated with a shorter course of treatment, were recruited from South Africa, Uganda, Zambia and India.
Minimal tuberculosis is regarded as non-severe lung or lymph gland TB, where the TB bacteria cannot easily be found in sputum through smear microscopy (smear negative). In 2020 alone, about 1.1 million children fell ill with TB globally, but approximately two-thirds had a non-severe form of the disease.
Until now, the treatment length of children with minimal TB was based on the results of trials in adults, requiring six months of a combination of daily medicines. As children on TB treatment often stay home from school, this also increases the burden on caregivers.
The study’s principal investigator, Diana Gibb, from the University College London, told Nature Africa that one of the reasons why research for TB in children has been neglected for long has been the difficulty in diagnosing the disease among children. “Often children don't take that treatment very well. They get better and they don’t keep the treatment going for six months, so having a shorter time to take it will be better for children,” Gibb said.
WHO updates guidelines
Based on the findings the WHO has updated its guidelines for the management of TB in children and adolescents. Children and adolescents who have non-severe forms of drug-susceptible TB are now recommended to be treated for four months instead of six months.
Tereza Kasaeva, director of the WHO’s Global TB Programme noted that children and adolescents with TB are lagging behind adults in access to TB prevention and care.
“The guidelines issued today are a game-changer for children and adolescents, helping them get diagnosed and access care sooner, leading to better outcomes and cutting transmission. The priority now is to rapidly expand implementation of the guidance across countries to save young lives and avert suffering,” Kasaeva said.
More than 1.3 million deaths were caused by TB in 2020 alone, including 214,000 deaths among people with HIV. While TB was the 13th leading cause of death worldwide, it is the top cause from a single infectious agent.
