Transcript Slide 1

Child TB: global and regional update
Ninth TAG meeting and NTP Managers Meeting
9-12th December 2014
Manila
Steve Graham
Centre for International Child Health, University of Melbourne
International Union Against Tuberculosis and Lung Disease
(The Union)
Child TB sub-group, Stop TB Partnership
The Meeting on the Development of Child Tuberculosis Action Plans in the
Western Pacific Region: HCMC, Viet Nam, March 2014
The objectives of the meeting were:
• To share country experiences, lessons learnt and best
practices;
• To establish priorities and design activities for strengthening
childhood TB initiatives in the Western Pacific Region; and
• To form a task force to oversee the activities and progress.
The meeting was attended by 21 country participants from 8
countries (Cambodia, China, Fiji, Lao PDR, Mongolia, PNG,
Philippines and Viet Nam). Each country team was composed
of focal point from NTP, maternal and child health programme
and paediatric association.
Also 17 observers participated the meeting from different
technical agencies.
Priorities for strengthening childhood TB activities in the WPR
1.
2.
3.
4.
5.
6.
7.
Improved political commitment and collaboration with
different stakeholders (e.g. MCH, EPI; partners like UNICEF,
World Vision; paediatric associations, private providers)
Improved case detection
Improved case management and logistical management
Improved prevention (BCG, IPT, infection control)
Improved recording, reporting and data analysis (including
private sector)
Improved awareness of community and capacity building
of health care worker
Operational research
Formation of a Regional Child TB Task Force
Participants of the Meeting formed an informal taskforce called 'The
Regional Childhood TB Taskforce' on the Development of Child TB Action
Plans in the Western Pacific Region
The Regional Childhood TB Taskforce will support members to finalise
national action plans and convene a regional workshop (with partners).
•
•
•
•
•
Chair: Steve Graham
Co-Chair: Dr James Amini (PNG); Dr Nguyen Thein Huong (Viet Nam)
Vice Chair: Dr Celine Garfin (Philippines); Dr Lin Zhou (China)
Members: All participants of the meeting
Secretariat: WPRO,WHO
Next meeting: Union APR conference, Sydney, August 2015
Objectives and activities of the taskforce
1. Increase awareness of the child TB disease burden in the AsiaPacific region
2. Assist the development of pragmatic, contextualized national
child TB action plans
3. Monitor & support implementation of these plans
4. Provide an education resource (training)
5. Facilitate collaboration/integration between programs for TB
and maternal and child health
Child TB at the new millenium
Childhood tuberculosis: out of control?
Donald PR. Curr Opin Pulm Med 2002
JR Starke
Putting child TB on the global public health agenda
Child TB subgroup of Stop TB Partnership formed 2003
Children recognised as a vulnerable group in need of increased casefinding: 2009
International Child TB Meeting, Stockholm, 2011
TB in the context of maternal and child health
Increasing recognition that TB is an increasingly important cause
of morbidity and mortality in infants and young children globally
Pregnancy-related TB – maternal and infant outcomes
Orphans due to TB – estimated to be around 9 million globally
Catastrophic economic costs of TB – families living with TB
TB in adolescents – uncertain burden and specific management
issues
Millennium Development Goals
Innovative approaches
Community-based
Wider health sector
Preventive therapy
Operational research
Roadmap for Childhood Tuberculosis
Launched Washington DC, October 1st 2013
Situational analysis a critical first step
“Know your epidemic”
TB in women – best estimate
3,300,000 cases
Deaths:
330,000 HIV negative
180,000 HIV positive
TB in children (0-14 yrs)
actual reported 275,000
15% smear-positive
54% smear-negative
31% EPTB
Best estimates:
550,000 cases and 80,000 deaths
Child TB working group and NTP
Age and sex-specific notification rates of new smear-positive
TB cases for the Western Pacific Region, 2012
Hiatt T & Nishikori N. WPSAR 2014
Age and sex-specific notification rates of new smear-positive
TB cases for the Western Pacific Region, 2012
Hiatt T & Nishikori N. WPSAR 2014
Risk of TB disease following infection by age
Adapted from Marais B, et al. Int J Tuberc Lung Dis 2004
Gap in surveillance
Incident (new) TB cases
Under-diagnosed
Gap
Under-reported
TB case
notifications
known to the NTP
Poor recording and reporting
Incident (new) TB cases
Under-diagnosed
Gap
Underreported
TB case
notifications
known to the NTP
From under-diagnosis
Incident (new) TB cases
Underdiagnosed
Gap
Under-reported
TB case
notifications
known to the NTP
to over-diagnosis
Not TB cases
Incident (new) TB cases
Underdiagnosed
Under-reported
TB case notifications
known to the NTP
Only 1.6% of 4,821 cases in children
were registered with NTP
Diagnosis of child TB in Java and level of care
TB cases
Inpatient
Outpatient
Overall
Total TB cases
5,877
15,694
21,571
Child TB cases
N=648
N=4173
N=4821
% of total burden
11%
27%
22%
< 5 years
56%
53%
53%
Smear positive disease
16%
8%
9%
EPTB
15%
6%
8%
Non-teaching hospital
73%
76%
75%
Private health facility
8%
7%
7%
Lestari T, et al. BMC Pub Health 2011
Burden of child TB in four provinces of PNG:
2005-6
Law I, et al. Poster – The Union Global Lung Health Conference 2008
Pulmonary TB
1208 (61%)
Smear positive
Smear negative
Smear not done
EPTB
18 (1%)
138 (7%)
1052 (53%)
769 (39%)
Total
1977
Child TB accounts for 30% of total TB burden
Pattern of EPTB disease in children in four provinces of PNG:
2005-6
EPTB cases
Lymphadenitis
Meningitis
Abdominal
Pleural effusion
Miliary
Spinal
Pericarditis
Bone disease
Not indicated/others
N=1097
342 (31%)
257 (23%)
173 (16%)
94 (9%)
64 (6%)
41 (4%)
12 (1%)
15 (1%)
99 (9%)
EPTB represented 39% of childhood TB cases
NATIONAL TB PROGRAM
PAPUA NEW GUINEA
MANUAL ON MANAGEMENT OF CHILDHOOD TUBERCULOSIS
Child TB working group and NTP
Rapid development of diagnostics
History
Bacteriology
Tuberculin
Skin Test
Chest X-ray
1882
1890
1896
Diagnostic yield for pulmonary TB comparing children to adults
Xpert cannot be used to rule out TB
Xpert needs research on implementation to inform
optimal usage in children
Union – MSF Operational Research Courses
TOTAL: 212 participants
Europe
Georgia
Ukraine
Estonia
Latvia
Belorussia
Asia
Moldova
Armenia
Azerbaijan
Denmark
Italy
India
Bangladesh
Pakistan
Afghanistan
Nepal
Bhutan
Sri Lanka
Timor Leste
Singapore
China
Mongolia
Uzbekistan
Vietnam
Myanmar
Indonesia
Cambodia
South Pacific
New Caledonia
Cook Islands
Tonga
Marshall Islands
Federated States of
Micronesia
Solomon Islands
Vanuata
Fiji
South America
Brazil
Peru
Africa
Kenya
South Africa
Ethiopia
Malawi
Zimbabwe
Benin
Somaliland
Rwanda
Uganda
Ghana
Tanzania
Burundi
Madagascar
Lesotho
Swaziland
Democratic Republic of the Congo
Sudan
Mozambique
Nigeria
Somalia
Sierra Leone
Liberia
MANAGEMENT OF TB IN CHILDREN
IN VIETNAM
Activities
2011 2012
Q3 2012
2013 2014
• Establish childhood TB working group in NTP
• Political will and policy
• Develop the national guidelines on management of TB in children including child
contact screening and diagnostic algorithms, treatment, forms and registers,
M&E forms, monitoring checklist, etc…
• Develop and distribute IEC materials
• Training – provide child TB training for NTP staff at provincial, district and
community level, and for pediatricians in 4 piloted provinces
• Provide Isoniazid, forms and registers with pilot implementation in 4 provinces
• Incorporate child TB into annual plans and 5-year strategic plan
• Include child TB data in routine reporting and reviews
• GFATM funding for rolling out to additional provinces in 2015
Community awareness – and support health worker!
12,750 posters
554,400 leaflets
Community contact screening in Viet Nam
Oct 2012-Dec 2013
Child contacts screened
4109
Eligible for IPT
1577
Numbers received IPT
979 (62%)
% completed to date
88% (n=153)
Children diagnosed with TB
345
Sputum smear positive
37 (11%)
Sputum smear negative PTB
157 (46%)
EPTB
151 (43%)
NATIONAL PLAN FOR
THE MANAGEMENT OF TB
IN CHILDREN: 2015-2020
Goal: To strengthen detection, treatment and preventive
therapy for Vietnamese children towards decreasing
childhood TB morbidity and mortality in Vietnam.
Regional activities in 2014
• WHO WPRO, Regional taskforce, Viet Nam, March
• China National Child TB, Beijing, August
• Global consultation on child TB for high burden
countries in EMRO, SEARO and WPRO, Indonesia,
September
“ There are many
contributions which the
pediatrician can make to
a TB control program.
First the negativism about
tuberculosis so prevalent
in pediatrics must be
overcome…”
Edith Lincoln, 1961
Donald PR. Edith Lincoln, an American Pioneer of Childhood Tuberculosis. Pediatr Infect Dis J 2013