Treat Adulthood TB To Prevent Childhood TB

Children are innocent victims of tuberculosis (which in Hindi is called Kshaya Rog—a disease which wastes away the body). According to the WHO over 250,000 children fall prey to the disease and 100,000 of them die every year from TB, for no fault of theirs. They can only blame their infected parents and elders, who inadvertently pass on the germs of TB to them. Adults infected with TB become potential transmitters of the disease to children. It is a one way transmission of the disease from adults to children, as children with TB usually do not infect the adults. 

Doctors, nurses, community activists, and other medical fraternity, all over the world, label adult TB as the main impediment in achieving zero TB infections in children. Dr Somya Swaminathan, a Scientist at National Institute for research in Tuberculosis (ICMR), insists that the only way to prevent TB in children is to tackle adult TB more seriously. Paediatric TB is difficult to control, because the infection spreads through the air borne route, and children get it from adults.
Unless we can diagnose and successfully treat the parent, we will fail to diagnose and treat the child. The majority of the children get TB disease from a parent or a close relative. It is not uncommon for small children to be carried around, and share the same bed, with a parent, grandparent and/or a sibling, especially in rural and semi urban areas of developing countries. This puts them to a great risk of infection in case their care giver is infected with the disease. The longer the exposure, the higher is the risk for infection. So diagnosis of any adult TB patient, especially mother or care giver, is crucial for a child’s health.
Hara Mihalea of PATH, Thailand, poignantly narrates the story of a 36 years old woman whom she met during one of her field visits. The woman was referred to the DOTS health centre, but was sent back home all of the 3 times, when she sought care, with just a bag of antibiotics and vitamins, and no TB treatment. This lack of treatment, not only endangered her well being, but also put her lactating infant and other two children under grave threat of becoming orphans and/or contracting the disease. Such scary incidents could be occurring in many parts of the world, especially in high TB burden developing countries. 

According to Professor Surya Kant, Head of the Pulmonary Medicine Department, Chhatrapati Shahuji Maharaj Medical University, “The first and foremost measure that can control childhood TB is to diagnose early, and treat successfully, adult TB. We have a large number of adult TB infections that can potentially be transmitted to children. Hence the more effectively we can cure adult TB, the better we will be able to prevent childhood TB.”

Dr Daisy Dharmaraj, Associate Professor Department of Community Medicine, ACS Medical College, also agrees that screening the communities for pulmonary TB and active case findings are crucial to reducing the infection in children.

Claire Crepeau, a Pediatric TB Nurse at McGill University, Canada, wants everyone to realize the dire need of controlling TB in children as they are the reservoir of TB for the future, if not treated timely. They should not be forgotten, especially in screening. So we must strive to manage adult TB properly if we are to decrease childhood TB and also prevent MDR TB.

Dr Anne Detjun, Technical Consultant, International Union Against Tuberculosis and Lung Disease (The Union), is apprehensive because a child infected with TB has a much higher risk of becoming sick with the disease, as compared to an adult (almost four times higher in case of infants under one year). Moreover the risk is high, not only of becoming ill, but also of getting very severe forms of tuberculosis such as TB meningitis and miliary TB. Hence preventive therapy is very important, especially in children under 5 years of age who are exposed to cases of infectious TB, so that they never actually contract the disease. 

Once an adult is diagnosed with TB then it is the responsibility of the health centre and of the community to ensure that all the members in the household of the patient, especially children, are screened for TB and started on chemo prophylaxis. There has to be intensified case finding and contact tracing, when TB is suspected, in all family members, most importantly in children. So one needs to "go back to the basics" of tackling the root cause of the problem— as soon as someone is identified with TB, immediately do contact tracing and consider prophylactic treatment in children. Diagnosing and treating TB in adults, will not only cure them, but also prevent them from becoming carriers of the disease in children. 

Dr Manoon Leechawengwong, from the Drug-Resistant Tuberculosis Research Fund, Thailand, also agrees that, “To prevent TB in children, adults in the family with active TB should be diagnosed and treated properly as soon as possible. They must adhere to the TB medications and strictly follow the doctor's instruction.”

As the experts say, if we can control adulthood TB, childhood TB will automatically taper off. Prevention of infection in children depends upon efficacy and coverage of adult TB control programs. Implementing the Patients' Charter for Tuberculosis Care; empowering communities to get engaged as equal partners with dignity in TB control; and ensuring that the programme addresses the need of reaching the unreached TB patients - adults as well as children-- will go a long way in getting to zero new infections. All health professionals need to partner their efforts to attain this goal with government support. A callous and uncaring health system will simply add fuel to fire of the epidemic.

In the words of Dr Muherman Harun of Indonesia –“If we only can persistently treat and diligently cure all of our TB patients who are infectious, eventually, there will be no more children getting infected! Hence, chase without delay, and retrieve any absconders who and wherever they are, at any cost! Provide patients the fullest treatment with the very best regimen available, so that the disease can be completely cured forever.”

Shobha Shukla - CNS
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. Email:, website: 

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