Paediatric tuberculosis in Europe: lessons from Denmark and inclusive strategies to consider

Abstract

Despite suffering high morbidity and mortality in tuberculosis (TB)-endemic areas, children with TB are generally less infectious than adult cases and are therefore low on the priority list of national tuberculosis control programmes [1]. Accurate disease burden assessment in children is hampered by diagnostic challenges [2], limited surveillance data and the poor quality of routinely collected programmatic data. In 2012, the World Health Organization (WHO) produced its first estimates of the TB disease burden suffered by children worldwide, which were updated in 2013: 530 000 cases and 74 000 child deaths were attributed to TB [3]. Many deficiencies were acknowledged and it probably is an underestimate given the conservative assumptions made [1]. However, it provided formal recognition of the plight of these children and supplemented the focus on paediatric TB during World TB Day commemorations in 2012. Despite improved awareness, pragmatic service delivery strategies are often lacking, with pronounced policy–practice gaps in TB-endemic areas with limited resources [3, 4]. This editorial puts recent paediatric TB trends in Denmark, as described by Hatleberg et al. [5] in this issue of the European Respiratory Journal , into perspective; it explores study findings that may seem counterintuitive, advises on the importance of consistent and accurate classification of clinical syndromes in order for reports to be more informative, and argues for new strategies to reduce TB transmission to a minimum in low-burden settings. Relatively good data exist on the paediatric TB disease burden in Europe. A descriptive analysis of European Union/European Economic Area surveillance data from 2000 to 2009 reported 39 695 paediatric cases, accounting for 4.3% of all notified TB cases [6]. Overall TB incidence rates in children <15 years of age dropped from 5.5 per 100 …