TB is a major killer of children in poor countries
Tuberculosis in children can be neglected. Paediatric TB does not have a high priority in many developing countries as fewer children than adults have the disease and children are not usually infectious, and often, limited resources mean that infectious cases have priority.
Vaccination is not 100% effective. The TB vaccine, BCG, does limit some of the severe forms of tuberculosis which are unique to young children, but by no means prevents them all. Tens of thousands “immunised” children in the developing world still suffer from tuberculosis meningitis and other forms of disease.
Children are highly susceptible to tuberculosis. The power to resist TB infection is normally poor in the first 5 years of life. The resistance can be further reduced by malnutrition, HIV, other childhood infections and worm infestations – all too common childhood conditions in poor countries. It has been estimated that as many as one third of the world’s population is infected with TB, and an estimated 20-50% of children who live in households where an adult has active tuberculosis become infected. Children are especially vulnerable to infection from household contacts as they are often held close and breathed on. The risk is particularly high in the developing world where family size is large, living quarters are crowded and more than half the population are children.
Traditional diagnosis of TB in children is ineffective. A vast number of children infected remain undiagnosed – creating a reservoir of future adult disease. Diagnosis is difficult in children, and often fatally delayed – early symptoms and signs of tuberculosis in children are common and easily missed. Lung TB is particularly difficult to diagnose early as children’s lungs react differently than adults, and they have little or no cough (thus not being able to provide sputum for testing) and, even if produced, microscopical examination only occasionally reveals the characteristic tubercle bacilli.
TB can have devastating long term effects on children who can be left deaf, blind and/or totally paralysed from TB meningitis, even after it is cured. Spread of infection to the bone can cause deformities of the spine (hunchback) or other permanent disabilities.
TB exacerbates poverty – it makes the patient and their family poorer because they may have to pay for treatment themselves, and even if TB drugs are free there is often a cost of travelling to clinics. If they cannot afford this they may default from treatment – leading to the added complications drug resistance. Children with TB lose out in the vital years of their education, which can affect their future wage-earning capacity.