Two cases of drug-resistant tuberculosis, international studies find children and teens to be under-represented

There is a stark underrepresentation of children and adolescents diagnosed with multidrug-resistant tuberculosis in case occurrences across studies, inclusive of cases in India. A fresh call from researchers is to better focus on the identification of cases in this age group.

MDR-TB occurs when the bacteria that cause tuberculosis become resistant to at least two or, most commonly, the most effective first-line drugs. Such resistance is highly detrimental in the quest to end the disease as it prolongs the duration of treatment and increases risk for further transmission.

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An analytical review was furthermore conducted to investigate trends in MDR-TB treatment among children and teenagers aged 18 and younger. One analysis, undertaken by researchers from India’s Ministry of Health and Family Welfare, involved 42 studies with data on more than 23,369 people, predominantly from India and South Africa.

Published in The Lancet Child and Adolescent Health, the findings show that nearly three-quarters of the children and adolescents undergoing treatment were cured successfully after an average treatment duration of 16 months. According to the experts, however, the very young ones, especially those under 5, are grossly underrepresented in this category. This is worrying because the largest majority of TB deaths in children occur in this age group and mostly without any treatment.

Older Teens at Higher Risk

An important finding of this study is that older teenagers, aged 15-19 years, accounted for almost 70% of cases. Researchers noted that TB in this age group demonstrates similar patterns to those seen in adults, rendering micro-biological confirmation easier.

In another review conducted by researchers from the University of Toronto, Canada, and published in PLoS Global Public Health, scientists examined 48 studies, including cases from India. They discovered that close to 90% of children and adolescents treated for extensively drug-resistant TB (XDR-TB), a more severe form wherein the bacteria have become resistant to nearly all effective drugs, attained success.

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Discouragingly, notwithstanding the success rates indicative of a promising outcome, very few cases of childhood XDR- and pre-XDR-TB have been reported. Treatment durations varied widely from six to 27 months.

These findings indicate there is a need to improve case identification, particularly among younger children, to permit timely treatment and, thus, lower the risk of death from TB.

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