Grania Brigden: Children with TB—global interest at last

Grania BrigdenAt last, tackling tuberculosis (TB) in children is on the international agenda. This year, for the first time, an estimate of the extent of TB in children was included in the Global Tuberculosis Report. Although the report acknowledged that the figures were approximate and probably too low, their inclusion ends the paucity of global paediatric TB data. Also in the past year, there have been advances in paediatric TB care. The growing awareness and focus on the plight of children was reflected in the 2012 International Union of TB and Lung Health Conference held last week in Kuala Lumpur with workshops, symposiums, posters, and plenary sessions on paediatric TB.

The crisis in diagnosis of paediatric TB was highlighted by data presented by MSF showing that current tests fail to diagnose drug sensitive TB in 9 out of 10 children. For children with drug resistant TB the numbers are even worse. The Sentinel Project is an international network of doctors and organisations committed to improving the diagnosis and treatment of children with drug resistant TB. At a workshop held by Sentinel in partnership with Médecins Sans Frontières (MSF), participants reviewed practical and positive measures that are increasing knowledge and awareness in this field. MSF presented data on the realities of treating paediatric drug resistant TB in Tajikistan, showing that it is challenging but possible. The Sentinel group launched their field guide on treating drug resistant TB in children, an easy to use guideline for those wanting to initiate or improve management of treatment programmes, giving practical advice on the whole process of clinical management through diagnosis, treatment, and follow-up.

Treatment of children with TB has long been hampered by the lack of paediatric appropriate drug formulations, but again, finally, there is hope in this area. This year the World Health Organisation (WHO) added recommended fixed dose combinations for treating children with drug sensitive TB onto the “Expression of Interest” list for manufacturers to submit products for evaluation for WHO prequalification—i.e. this should encourage drug manufacturers to produce paediatric TB drug formulations. UNITAID held a sponsored session on innovative approaches used to encourage a healthy market for paediatric TB drugs, acknowledging the challenges and importance of getting manufacturers interested in this area. Hopefully lessons learned in the development of formulations for drug sensitive paediatric TB and interest from donors will ensure that similar delays will not occur when paediatric formulations of drug resistant TB drugs are developed. The first step in the development of these drugs was presented at the TB Conference last week—the initial results of pharmacokinetic data on the doses required for second line drug resistant TB drugs in children.

The growing interest and focus on children with TB must continue if the deficit of knowledge, research, and developments in their treatment and diagnosis are to be addressed. And it is vital that children are not excluded from efforts to improve the current ineffective regimens for treating drug resistant TB. New models of care, trials of new TB drugs, and new treatment regimens should consider the needs of children now rather than leaving them behind yet again.

Grania Brigden is the TB advisor for the MSF campaign for access to essential medicines.