A recent study has evaluated tuberculosis (TB) infection and active TB disease during the first ten years of life in areas heavily affected by the disease. The findings revealed a consistently high annual rate of TB infection among the children included in the study, ranging from 4% to 9%, with over 10% of them developing TB disease by the age of 10. This study expands on earlier research conducted by some team members, which also identified elevated rates of TB infection and disease in children up to five years old.
The new findings highlight that children residing in high TB burden areas face a persistent and elevated risk of acquiring TB infection throughout their childhood.
Each year, around 1.2 million children are diagnosed with tuberculosis disease, and 200,000 children die from it globally. However, the risk of acquiring TB infection and developing the disease during childhood is still not thoroughly examined. Additionally, most research regarding pediatric TB is based on data from healthcare facilities rather than community settings.
Led by researchers from Boston University School of Public Health (BUSPH), the University of São Paulo, and the University of Cape Town, this study sheds light on the risks associated with TB infection and disease in children under ten living in areas where TB is prevalent.
Published in The Lancet Child & Adolescent Health, this research represents the first birth cohort study to investigate TB infection and active TB disease in children within high-burden areas. The findings indicated that the annual rate of TB infection among the study cohort ranged from 4% to 9%, and over 10% of the children developed TB disease by their tenth birthday. This current analysis enhances the previous findings from some of the same researchers, which noted significant rates of TB infection and disease in children aged five years and younger.
“These findings are alarming and demonstrate that children in certain South African communities face an extremely high risk,” stated Dr. Leonardo Martinez, a senior author of the study and assistant professor of epidemiology at BUSPH. “It’s quite possible that 1,000 to 2,000 South African children are at a far greater risk for TB compared to their peers in the United States. It clearly represents an urgent health challenge with both immediate and long-lasting consequences for these children and their families.”
During the study, Dr. Martinez and his team tracked a group of 1,137 pregnant women and their 1,143 children enrolled in the Drakenstein Child Health Study, situated near Cape Town, South Africa, between 2012 and 2023. The children were tested for TB infection and disease at six months, twelve months, and then annually if initial tests were negative, in addition to assessments when they experienced lower respiratory tract infections.
By age eight, the researchers estimated that the cumulative risk of developing TB infection among the children reached 36%. The incidence of TB disease was notably highest during the first year of life. Although this risk diminished as the children grew older, the fact that 1 in 10 children developed TB disease by the age of 10 remains concerning, as it suggests that this demographic may face compromised immune systems, potentially leading to future health complications in young adulthood and later in life.
Fortunately, TB can be effectively treated with medication, and the researchers discovered that preventive treatments were generally successful for infected children who received them – yet only a small fraction of the study cohort accessed this care. Many eligible children with TB infection did not receive preventive treatment, and a substantial number who developed TB disease had not been given any preventive medication.
“In spite of adequate nutrition and very few children living with HIV, there was a startlingly high incidence of TB infection and disease in this cohort,” remarked Dr. Heather Zar, co-senior author and principal investigator of the Drakenstein Child Health Study. Many children diagnosed with TB disease were found to have acute pneumonia, indicating that in areas with high TB prevalence, children presenting with pneumonia should be screened for TB.”
As part of its Sustainable Development Goals, the World Health Organization aims to reduce TB incidence by 80% and TB-related deaths by 90% by 2030, while also alleviating the financial burden on those affected by the disease. Reducing pediatric TB cases is a vital aspect of this goal, which requires a comprehensive strategy, according to the researchers.
Dr. Martinez emphasizes that there remains significant work to address the pediatric tuberculosis crisis in South Africa and other high-burden nations. “To effectively reduce pediatric tuberculosis on a global scale, a collaborative approach is essential, bringing together researchers, policymakers, healthcare providers, funders, and advocates to discover holistic solutions.”