Tuberculosis Prevention: an Under Prioritized yet Critical Intervention to Reduce Child Tuberculosis Morbidity and Mortality

Abstract

Identification of vulnerable household tuberculosis (TB) contacts, particularly children under 5 years of age, has been recommended for over 10 years by the World Health Organization (WHO), but uptake has been poor in TB high-burden settings where this intervention is most needed. In part due to this failure of TB contact management, the burden of TB disease in children under 5 years of age is grossly underestimated leading to increased morbidity and mortality. In light of these unfortunate realities, it is critical to identify children exposed to TB and provide preventive treatment before they progress to active TB disease. This review highlights the role of TB prevention for children under 5 years of age and suggests strategies for improved TB prevention in high-burden settings. There have been examples of both programmatic and non-programmatic interventions that have successfully improved TB contact management and preventive therapy implementation. Here, we discuss some of these interventions and use the WHO health system building blocks to provide recommendations for improving TB prevention through isoniazid preventive therapy. Further, we describe the significant contributions of the BCG vaccine to TB prevention in young children and the need to ensure continuous supply of this critical vaccination. Without such devotion to TB prevention, we are unlikely to meet the global END TB targets, and children under 5 years of age will continue to experience preventable morbidity and mortality secondary to TB disease.