Today, as the world commemorates World Tuberculosis Day, it is important to know that 24 March 1882 was the day Dr Robert Koch announced his discovery of the bacterium that causes TB.
World TB Day is observed each year to raise awareness and understanding about one of the world's top infectious killers and catalyze action, progressives, devastating health, social and economic impact around the world.
The theme of world TB day 2022 is "Invest to End TB. Save Lives.". This is much-needed due to the reversal of gains in the TB response caused by the COVID 19 pandemic, as well as the ongoing conflicts in Eastern Europe, the African region and the Middle East that puts progress at risk, according to World Health Organisation.
According to Dr Teresa Kasaeva, Director of WHO's Global TB Programme, it was reported late 2021 that TB deaths increased for the first time in over a decade, with Covid-19 causing major disruptions to access to TB care. According to the data reported mostly from 90 countries, there has been insufficient progress made in closing case detection gaps. Far fewer people have been diagnosed and treated or provided with TB preventive treatment compared with 2019 before the Covid-19 pandemic.
"The situation is even worse for children and adolescents with TB. An estimated 63% of children and young adolescents below 15 years of age with TB were not reached or not officially reported to have access to life-saving TB diagnosis and treatment services. In 2020, the proportion was even higher 72% for children under five years. Almost two thirds of eligible children under five didn't receive TB preventive treatment and therefore remain at risk of illness", says Dr Kasaeva.
According to Dr Kasaeva, "socio-economic consequences of the Covid-19 pandemic compounded by the ongoing crisis and conflict in Eastern Europe, Africa and in the Middle East have further exacerbated the situation, especially for the most vulnerable. This is why for World TB Day this year, our call and focus is on the theme "Invest to End TB. Save Lives." 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."
"Ending TB by 2030 can lead to avoiding 23,8 million tuberculosis deaths and almost U.S.$13 trillion in economic losses. Investments in TB programs have demonstrated benefits not just for people with TB, especially during pandemic but for healthy systems for strengthening health system and pandemic preparedness," says Dr Kasaeva.
According to WHO, children and adolescents with TB are lagging behind adults in access to TB prevention and care. The new WHO guidelines are a game changer for children and adolescents with TB. WHO looks forward to the rapidly expanded implementation of the guidance across countries to save young lives and avert suffering.
"WHO estimates that 1.1 million children and young adolescents become ill with TB every year, almost half of them age below five years of age. Unfortunately, less than half of these children and adolescents are diagnosed or reported, which means that there is a large detection gap. In addition in 2020 approximately 226,000 children died due to TB. And again, most of these children did not access TB care, as well as the gap in detection", says Dr Kerri Viney, Team Lead at WHO's Vulnerable Populations, Communities and Co-morbidities Unit, Global TB Programme.
"There's also a gap for prevention. Children who are in close contact with a person with infectious TB can benefit from TB preventive treatment which reduces their risk of developing TB disease. However, for children aged under five years, almost two thirds of those who were eligible for this preventive treatment didn't receive it", says Dr Viney.
"To close these gaps and to further improve the management of TB in children and adolescents in 2021, the global TB program at WHO reviewed its recommendations on the management of TB in this vulnerable group. We assess the latest scientific evidence from several studies. The result of this process is updated and consolidated recommendations on the management of TB in children and adolescents along the full pathway of care. So that is for screening, prevention, diagnosis, treatment and the provision of care the WHO guidelines are being launched on the occasion of World TB day alongside an operational handbook, which is designed to provide practical guidance on how to implement the recommendations", adds Dr Viney.
The new recommendations include:
- the use of rapid molecular diagnostic tests called Xpert Ultra to detect TB using non invasive specimens such as stool as well as other specimens.
- the inclusion of these tests in algorithms, which allow healthcare workers at all levels of the health system to make a more informed decision to treat a child for TB.
-a new recommendation on a shorter regimen to treat children with mild or non severe forms of TB from six months to four months
- the newest TB medicines to treat drug resistant TB, called Bedaquiline and delamanid are now recommended for use in children of all ages, including for newborn babies. This means that everyone with drug resistant TB, including all children can benefit from regimens that consist of oral medicines only. There is no longer a need for painful injections that can have serious side effects, including deafness.
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- a new recommendation on a six month regimen to treat TB meningitis as an alternative to the currently recommended 12 month regimen. This six month regimen based on medicines and doses of medicines that better penetrate the side of disease, which is the meninges or the lining around the brain was shown to reduce deaths among children with TB meningitis.
- a new recommendation on the provision of decentralized and integrated TB care, in addition to more centralized or specialized services. This will allow more children and adolescents to access TB care or preventive treatment closer to where they and their families live reducing delays and costs when accessing TB services.
The new WHO guidelines represent a significant step forward for children and adolescents with TB or at risk of TB in close collaboration with technical partners donors, WHO will now assist countries to rapidly adopt and implement the new recommendations to ensure that children, adolescents and families can benefit from high quality TB services. This is part of the WHO's aim and mandate to end TB in children and adolescents by the year 2030 in line with the United Nations Sustainable Development Goals and the milestones of the NTB strategy.
