WHO Issues New TB Guidelines for Children and Adolescents

Lucy Hicks

March 21, 2022

The World Health Organization (WHO) now recommends shortened treatment for children with mild tuberculosis (TB), as well as two oral TB treatments (bedaquiline and delamanid) for use in children of all ages. The updated guidelines for TB management in children and adolescents were announced March 21 ahead of World Tuberculosis Day on March 24.

The agency also called for increased investment in global TB programs, noting that in 2020, TB deaths increased for the first time in over a decade. "We cannot falter in our commitment to reach and save every man, woman, child, family, and community impacted by this deadly disease," said Tereza Kasaeva, MD, PhD, director of the WHO Global Tuberculosis Programme during a press conference.

TB is the 13th-leading cause of death and the second top infectious killer after COVID-19, with more than 4100 people dying from TB every day. WHO estimates that 1.1 million children fall ill with TB each year.

Calls for Investment

The increase in TB deaths from 1.4 million in 2019 to 1.5 million in 2020 was coupled with a decrease in funding. From 2019 to 2020, global spending for TB diagnostic, treatment, and prevention services fell from $5.8 billion to $5.3 billion. This is less than half of the $13 billion target funding amount for 2022, Kasaeva said.

Efforts to expand access to TB care have fallen short mainly because of this lack of funding, especially for children. In 2020, about 63% of children under 15 years of age with TB either did not receive or were not reported to have access to TB diagnosis and treatment services, which rose to 72% in children under age 5. Almost two thirds of children under age 5 also did not receive TB preventive treatment in 2022, according to WHO statistics.

The socioeconomic ramifications of the COVID-19 pandemic as well as ongoing conflict in Eastern Europe, Africa, and the Middle East have "further exacerbated the situation," Kasaeva said. "This conveys the urgent need to dramatically increase investments to ramp up the fight against TB and achieve commitments to end TB made by global leaders."

Kasaeva laid out WHO's main points for global investment in TB care:

  1. Increase domestic and international funding to close gaps in TB research and program implementation. For countries with smaller economies, increased international investment will be necessary in the short or medium term to help regain progress.

  2. Double funding for TB research, including vaccines.

  3. Invest in sustaining TB programs and services during the COVID-19 pandemic and ongoing crises so care is not disrupted.

New Guidelines

Kasaeva also noted that adoption of WHO's new guidelines for children and adolescents should be fast-tracked to improve access to and quality of care. The updates include:

  • Rapid molecular tests called Xpert Ultra should be used as the initial test for TB in children and adolescents.

  • Diagnostic testing can now include noninvasive specimens, like stool samples.

  • Children with mild TB can be treated with a shorter regimen of 4 months, rather than 6 months. This shortened regimen will allow children to return to school faster and save money for families and the healthcare system, said Kerri Viney, MD, PhD, a team lead for the WHO Tuberculosis Programme, with a focus on vulnerable populations including children. She presented the new guidelines during the WHO press conference.

  • The recommended treatment regimen for TB meningitis has also been shortened from 12 to 6 months.

  • Two oral medications for drug-resistant TB (bedaquiline and delamanid) are now recommended for use in children of all ages. "There is no longer a need for painful injections that can have serious side effects, including deafness," Viney said.

  • Health systems should develop new models of decentralized and integrated TB care to bring TB care closer to where children live.

The guidelines are available here.

"The WHO guidelines issued today are a game changer for children and adolescents with TB," Kasaeva said. The next step is assisting countries in implementing these updates so that children and adolescents globally have access to high-quality TB care," Viney added. "We have the policy recommendations. We have the implementation guidance, we have child-friendly formulations of TB medicines," she said. "Let us not wait any longer. Let us invest to end TB in children and adolescents."

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