- TB —
- WHO —
- World Health Organization
Why are we still struggling to control the devastating effects of childhood tuberculosis? This disease has been with us since ancient times and yet, even with known effective prevention and treatment strategies, much of the world has unacceptable levels of childhood morbidity and mortality due to tuberculosis. As expected, progress in identification and treatment has occurred primarily in high-income countries. Dr Starke’s column captures the current state of affairs and highlights the needed actions that would make a difference for millions of children’s lives.
Jay E. Berkelhamer
Despite the availability of inexpensive diagnostic tests, curative and preventive therapies, and the widespread use of the BCG vaccines, tuberculosis (TB) remains an important cause of morbidity and mortality, and its lack of control is one of our biggest public health failures. Childhood TB has been a troublesome and largely neglected subject for organizations dedicated to TB or child health. A clinical diagnosis usually can be established by using epidemiology (especially recent contact with a case subject) and clinical findings such as symptoms, radiography, and a test for TB infection. However, because of its paucibacillary nature, TB is difficult to confirm microbiologically with sputum smear or culture specimens. Given the reliance on sputum microscopy for diagnosis and reporting cases in most high-burden countries, the majority of childhood TB cases are not diagnosed; for most of those cases that are diagnosed clinically, the World Health Organization (WHO) is not notified. Over the last 20 years, there has been a veritable explosion of research on childhood TB. Although microbiologic confirmation of childhood TB remains elusive, we have effective and safe regimens for treating TB disease and infection, and we know that early intervention via contact tracing and treatment can prevent many cases of childhood TB. The goal is for no child to die …
Address correspondence to: Jeffrey R. Starke, MD, Texas Children’s Hospital, MC 3-2371, 1102 Bates St, Houston, TX 77030. E-mail: