A study by researchers from Kasturba Medical College (KMC), Manipal, and ESIC Medical College and Post Graduate Institute of Medical Sciences and Research, Rajajinagar and State Tuberculosis (TB) division in Bengaluru and Udupi districts has found high rates of paediatric TB infection among household contacts of TB patients.
While 50% of the 686 children (below 15 years) examined in the study were found to be infected, the infection had developed into the disease in 3%. Nearly 80% of these cases occurred in the 6-15 years group. The study titled “TB screening for paediatric household contacts in India: Time to adapt newer strategies under the National TB Elimination Programme (NTEP)” was published in PLOS ONE, an open access journal, on October 5.
Led by Kiran Chawla from KMC and Sharath B.N. from ESIC, the study is aimed at evaluating the effectiveness of screening paediatric household contacts (under the age of 15 years) for TB through verbal screening, tuberculin skin testing (TST) and chest radiography at intervals of 0, 3, 6, 9, and 12 months. The study was funded by the Central TB Division, Union Ministry of Health and Family Welfare.
NTEP guidelines
“The current NTEP guidelines only require verbal screening for contacts under six-years-old at TB treatment initiation. The study aimed to fill this knowledge gap and provide valuable insights for improving TB screening in paediatric household contacts in India,” said Dr. Sharath.
Conducted from January 2021 to December 2022, the research utilised a cohort study design to enrol contacts of index TB cases diagnosed under NTEP.
Pandemic challenges
Dr. Chawla said the COVID-19 pandemic posed significant challenges to regular follow-up screenings, making it difficult to assess and treat potential cases in a timely manner. “A substantial number of parents did not subject their children to screening due to the absence of visible symptoms, highlighting the importance of multiple screenings. The study recommends a revision of the screening policy for household contacts, advocating for at least three screenings a year involving symptom screening, chest radiography, and TST or other non-invasive tests,” she said.
“The study reveals significant hurdles, especially when it comes to paediatric cases,” the doctor said.
Gender disparities
Another author Suresh Shastri, State Programme Officer (Ayushman Bharat Arogya Karnataka), who was then Senior Specialist in the State TB division, said females above six years of age were found to be at a 22% more risk of contracting TB compared to males in the same age group.
“This research serves as a clarion call to re-evaluate existing screening policies and prioritise early detection and treatment of paediatric TB cases,” the study pointed out.
