Abstract
The epidemiology of tuberculosis, particularly in children, is highly intertwined
with socio-political factors, such as poverty, access to healthcare, and migration.
Growing evidence around the world shows that more children have tuberculosis (TB)
than was previously thought, most of whom are undiagnosed and untreated, and that
TB is a significant cause of morbidity and mortality in children in TB endemic areas.
Since TB in young children results from recent transmission, the incidence of pediatric
TB is a marker of epidemic control in a community and an indirect indicator of the
effectiveness of TB control programs. It is estimated that pediatric TB represents
between 4 and 21% of all TB cases, depending on the background prevalence in the country,
and at least 10 to 20% of the total cases in areas with poor epidemic control. However,
a precise estimate of the global burden of TB in children is difficult due to challenges
in case ascertainment, diagnosis, and weak surveillance systems in many countries
with a high burden of disease. Several recent estimates highlight these difficulties
and provide a starting point to motivate further study. In addition, since drug-resistant
TB in young children reflects transmission of resistant strains in the community and
occurs with the same frequency as in treatment-naive adults, accurate monitoring of
drug-susceptibility patterns in pediatric TB cases will inform optimal empiric treatment
regimens in both adults and children, in the context of increasing rates of drug-resistant
TB globally.
Keywords
child - epidemiology - global - tuberculosis - mortality - multidrug-resistant
