Chapter 15 Tuberculosis in children and adolescents: a forgotten group in a forgotten disease Elisa López-Varela 1,2,3 ,Isabelle Munyangaju 1,4 ,Chishala Chabala 5 ,Moorine Sekadde6 and James A. Seddon 3,7 1 ISGlobal, Hospital Clínic Universitat de Barcelona, Barcelona, Spain. 2 Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique. 3 Desmond Tutu TB Centre, Dept of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. 4 Mozambican National TB Program, Maputo, Mozambique. 5 Dept of Paediatrics, School of Medicine, University of Zambia, Lusaka, Zambia. 6 National Tuberculosis and Leprosy Programme, Kampala, Uganda. 7 Dept of Infectious Disease, Imperial College London, London, UK. Corresponding author: Elisa López-Varela ( Cite as: López-Varela E, Munyangaju I, Chabala C, et al. Tuberculosis in children and adolescents: a forgotten group in a forgotten disease. In: García-Basteiro AL, Öner Eyüboğlu F, Rangaka MX, eds. The Challenge of Tuberculosis in the 21st Century (ERS Monograph). Sheffield, European Respiratory Society, 2023 pp. 210–234 []. @ERSpublications TB in children and adolescents is associated with high morbidity and mortality. However, new guidelines, including shorter treatment regimens, can help address some of the unique challenges faced by this population. Copyright ©ERS 2023. Print ISBN: 978-1-84984-169-6. Online ISBN: 978-1-84984-170-2. Print ISSN: 2312-508X. Online ISSN: 2312-5098. Despite being both treatable and preventable, TB in children and adolescents continues to cause substantial mortality and morbidity in high-incidence settings. Major challenges include missed opportunities for TB prevention and poor case detection, particularly in young children. Although historically neglected, recent developments, including the 2022 WHO child and adolescent TB guidelines, represent important milestones in improving TB prevention and care in this population. The guidelines include the use of treatment decision algorithms, shorter treatment regimens, and TPT for both drug-susceptible and DR-TB, as well as steps to address the unique needs of adolescents. Closing persistent policy-practice gaps will be necessary to ensure that these new developments are implemented effectively. This chapter emphasises the need for continued efforts to prevent and control TB in children and adolescents, which will require a multifaceted approach involving governments, health systems and communities. Introduction Childhood TB has historically been a near-invisible part of the global TB epidemic. This can be attributed to several factors, including a reliance on sputum smear microscopy for diagnosis. Only a few children were historically confirmed microbiologically, leading to poor quantification of the disease burden. Childhood TB lags behind progress in adults in our understanding of disease burden and also in research and development of diagnostics and treatments. Yet children are particularly vulnerable to developing TB disease after exposure, which can progress to severe forms of the disease, including TB meningitis (TBM). Older 210
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