About one quarter of the world’s population is infected with tuberculosis (TB) bacteria, as per the World Health Organization (WHO). Although the bacterial infection is preventable and curable, it continues to a major global health challenge.
A recent study has revealed that there is a rising incidence of multidrug-resistant tuberculosis (MDR-TB) among children and adolescents worldwide. The findings of the study were published in paediatric Research journal.
According to the study, the global burden of MDR-TB among children and adolescents has increased from 1990 to 2019. The emergence of multidrug-resistant tuberculosis (MDR-TB) in recent years is hampering the efforts to control TB worldwide.
“MDR-TB is characterized by resistance to both isoniazid and rifampicin and is closely linked to previous TB infections and their treatments. As MDR-TB prolongs the treatment cycles and worsens the prognosis, it has emerged as a major health and economic burden,” the study stated.
While the incidence saw fluctuations over the years—a sharp rise from 1990 to 2005, a slight decline from 2005 to 2015, and a resurgence from 2015 to 2019—certain regions continue to bear the highest burden. Eastern Europe, Southern sub-Saharan Africa, and South Asia recorded the most significant caseloads, with girls being more susceptible than boys.
The study estimates that in 2019 alone, 67,710 children and adolescents contracted MDR-TB, leading to 7,061 deaths. Children under five years of age were found to be the most vulnerable, exhibiting the highest mortality rates (0.62 per 100,000 in 2019) despite having lower overall incidence compared to older children (15-19 years).
The study found that MDR-TB incidence among children and adolescents is rising at 4.15 percent annually. Younger children (<5 years) are more vulnerable to mortality, while older children (15-19 years) have higher infection rates. The disease is more prevalent in low-income regions, with India, China, South Africa, and Russia accounting for over 60% of cases. Eastern Europe, Southern sub-Saharan Africa, and South Asia are among the worst-affected regions, it stated.
‘Underreporting continues to be a critical challenge’
Dr Shreya Dubey – Consultant – Neonatology & Paediatrics, CK Birla Hospital Gurgaon revealed that children are highly vulnerable to TB because of their underdeveloped immune systems.
“They get the disease mostly from adults, commonly within their family. It is difficult to diagnose TB among children because of the non-specific symptoms of the disease and the problems of sputum samples for testing. Such a diagnostic issue is compounded even more in MDR-TB cases, thus resulting in late treatment and poorer outcomes,” Dr. Dubey told Financial Express.com.
The World Health Organization (WHO) has estimated that 30,000 children develop MDR-TB annually. Yet, this is a probable underestimation considering the underreporting and underdiagnosis of MDR-TB, she explained. Child MDR-TB is also more common in countries with a high burden of drug-resistant TB among adults, for example, parts of Eastern Europe, Central Asia, and India, Dr. Dubey highlighted.
According to Dr. Dubey, diagnosis of MDR-TB among children is subject to a number of challenges:
- Paucibacillary Character of Paediatric TB: There are fewer bacteria in the sputum of children, so it is hard to find them using conventional tests such as sputum smear microscopy.
- Specialised Tests Necessary: Drug susceptibility testing to diagnose MDR-TB might not be easily found in all environments.
- Extrapulmonary TB: Children tend to present with extrapulmonary TB, which is more challenging to diagnose than pulmonary TB.
Why MDR-TB treatment in children is complicated?
MDR-TB is more complicated due to resistance to conventional therapies, increase in the treatment duration and adverse drug reaction.
“First-line drug resistance requires second-line drugs, which are less effective and more toxic. Treatment of MDR-TB takes much longer than drug-susceptible TB, involving adherence over a prolonged duration. Children can develop serious side effects from MDR-TB drugs, necessitating close monitoring and management,” Dr. Dubey told Financial Express.com.
The Way Forward
According to Dr. Dubey, in order to effectively battle the emergence of MDR-TB among children, a multi-faceted response is imperative:
- Strengthening Infection Control: Introduction of rigorous infection control practices within healthcare institutions and communities is paramount to check MDR-TB transmission.
- Enhancing Diagnostic Capability: Enhancing access to prompt molecular diagnostic techniques and drug sensitivity testing is instrumental in achieving prompt diagnosis.
- Securing Access to Treatment: Offering complete treatment for MDR-TB in children, such as access to second-line medication and pediatric-suitable formulations, is vital.
- Improving Surveillance: Improving surveillance systems so that the incidence of MDR-TB among children can be correctly recorded is important for tracking progress and pinpointing hotspots.
- Investing in Research: More research has to be done to create more effective diagnostic methods, treatments, and preventive measures for MDR-TB in children.