Fodder Points;

• About 5,500 of over 76,000 children tested in nine Indian cities have been diagnosed with tuberculosis, 9% of them with multi-drug resistant TB (MDR-TB).
• Though the actual prevalence of MDR-TB among children in India is not known, the results from a limited number of children tested in this sample, under the Revised National TB Control Programme, is worrying.
• According to a 2015 study, of the over 600 children who had tested positive for TB in four cities, about 10% showed resistance to Rifampicin, a first-line drug.
• Since the incidence of TB among children is a reflection of the prevalence of the disease in the community at large, the high prevalence of both drug-sensitive TB and drug-resistant TB in children from these nine cities is a grim reminder of the failure of the health-care system to diagnose the disease early enough in adults and start them on treatment.
• Children who test positive for TB have been in close contact with adults with the disease in the same household.
• There is a continuing threat of TB spreading among household contacts and in the larger community.

Background:

• In line with World Health Organisation guidelines, the RNTCP requires all household contacts, particularly children, of a newly diagnosed pulmonary TB patient to be tested and started on treatment if needed.
• Children below six years of age in the household of a newly diagnosed patient are required to be given the drug Isoniazid as a prophylactic even when they do not have the disease.

Way Ahead:

• A proactive approach to testing helps in early and correct diagnosis of all contacts and in cutting the transmission chain.
• Unfortunately, as several studies have shown, the RNTCP guidelines on contact screening are heeded mostly in the breach.
• The results from this limited study should now compel the government to take up contact screening more urgently.
• In 2010, WHO had revised the dosage of certain TB drugs for children.

Using Fixed Dose Combination:

• Fixed-dose combination (FDC) drugs that take into account the revised dosages for children were finally made available in late 2015.
• The FDCs are meant for treating children with drug-susceptible TB and cannot be used to treat children who require second-line drugs or who have MDR-TB.
• After more than a year’s delay, a few months ago India finally introduced FDCs in six States. The remaining States will be covered by the end of this year.
• Adherence to treatment will improve, and correct dosage for children weighing less than 25 kg will become easier when child-friendly FDCs become available throughout the country.
• Using the Xpert molecular diagnostic test to screen children with TB is a positive step and should be welcomed, but all the diagnosed children should be guaranteed paediatric FDCs. 

Source:TH