Tuberculosis: The special needs of children

Abstract

Mycobacterium tuberculosis infects one-third of the world's population and is a leading cause of morbidity and mortality, particularly in poorer countries and underresourced communities where tuberculosis (TB) is endemic. Although childhood TB is largely preventable, children living in these areas are extremely vulnerable to the development of disease as a result of the interplay of environmental, social, and medical/health systems factors. TB disease is the end result of a progression from exposure to an infectious case, to infection and subsequent development of symptoms. Young and immune-suppressed children progress more rapidly and develop more severe forms of disease. The health care needs of children in TB-endemic areas are being neglected both by the global community and by the local governments. In order to prevent TB, children require adequate nutrition, hygienic living spaces, access to education, and health care. These basic needs are largely unmet in countries where governments are unstable, and where resources are limited or inequitably distributed. In addition, children require strong health systems, where infectious adults are identified and promptly treated, and where child contacts of such adults are administered timely prophylactic therapy. Vertical transmission of HIV needs to be eliminated and HIV infection appropriately treated. A safe and effective vaccine should be a global research priority.