Drug-resistant TB a looming threat over children in India
Tuberculosis is one of the oldest maladies known to humans. The silent spread of the disease in India was recently highlighted by the fact that out of about 76,000 children tested in nine Indian cities, around 5,500 have been diagnosed with tuberculosis. Moreover, about 9% of them diagnosed with multi drug resistant TB (MDR-TB). While the actual prevalence of multi drug resistance TB in children in India remains unknown, the results from children tested in this sample are something to be pondered over.
According to a study conducted in 2015, about 10% of over 600 children who were tested positive, showed resistance to a first-line drug called ‘Rifampicin’. TB among children in India is a grim reminder of the widespread prevalence of the disease, as well as of the failure of the healthcare system to diagnose the disease early enough in adults and start them on treatment.
Children who test positive for TB have often been in close contact with adults with the disease in the same household. With a usual delay of up to a couple of months diagnosing the disease, there is a continuing threat of TB spreading among household contacts and in the larger community.
According to the guidelines of Revised National Tuberculosis Program (RNTCP), all household contacts of a newly diagnosed pulmonary TB patient, especially children, need 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 if they do not have the disease.
Early and correct diagnosis of all contacts can be facilitated by adopting a proactive approach to testing. However, as unfortunate as it is, several studies have shown that the RNTCP guidelines on contact screening are usually ignored by doctors and diagnostic centers alike. The results from these studies should now compel the government to take up contact screening more urgently.
In 2010, WHO had revised the dosage of some fixed-dose combination (FDC) drugs for children. After the revision in the dosages, the drugs were finally made available in late 2015. The FDCs are used for treating children with drug-susceptible TB. India finally introduced FDCs in six states a few months ago, after more than a year’s delay. The remaining states are supposed to be covered by the end of 2017. Once the FDCs are available throughout the country, the correct dosage for children weighing less than 25 kg will become easier. The use of Xpert Molecular Diagnostic Test to screen children with TB is a positive step towards the early diagnosis of TB in children. However, all the children diagnosed with TB should be provided with pediatric FDCs.