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correspondence

Indian Pediatr 2011;48: 738

Tuberculosis Infection in Children: Need to Strengthen and Intensify Control Efforts


*T Jacob John and Vipin M Vashishtha

439 Civil Supplies Godown Lane, Kamalakshipuram, Vellore, TN, 632 002, India.
Email: [email protected]

*Corresponding author
 


Yadav, et al. [1] reported the annual risk of tuberculosis infection (ARTI) of 1.2-1.6% and infection prevalence of 6.3-8.2% in tribal children <10 years in Madhya Pradesh. These metrics are similar to those in other tribal populations and in general populations throughout India [1]. They conclude stating: "there is need to strengthen and further intensify TB control measures in the area," implying that current measures are failing. Other recent papers also have illustrated the failure of TB control in spite of long-standing efforts of the Ministry of Health [2,3]. National TB Control Programme (NTCP), started in 1962, was evaluated in 1990-92 and found to have failed [4,5]. The Revised NTCP (RNTCP) was launched in 1992-93 [4,5]. Control status requires reduction of cumulative infection prevalence to <1 in children by 14 years of age and ARTI of ~ 0.07% [3-5]. However, ARTI remains >1% over decades; infection prevalence in orders of magnitude higher than desired [1-4]. Nationally, there is no decline in incidence or prevalence of TB in adults [5].

Why has TB not come under control? Treatment of the infectious form of TB has not been validated sufficient for control [2-4]. Treatment can be given only to persons captured in the diagnostic net, but it does not capture all infectious cases, allowing many to seek private healthcare, wherein non-standard treatment is rampant, and follow up poor, contributing to development of drug resistance. The sensitivity of TB diagnosis is inadequate without micro-biological diagnostic support. Even those captured in RNTCP become non-infectious only after they have shed the bacilli for several weeks. Thus chains of infection continue unabated and ARTI remains high in all studies [1-4].

RNTCP must be revamped, deficiencies covered, interfaced effectively with healthcare (public and private sectors), and supported adequately with laboratory facilities [2-4]. Infection incidence must be regularly monitored in all districts by systematic surveys of ARTI [2-4]. Pediatric TB infection and disease must be given high priority for detection and treatment [2-4]. Such strengthening and intensification of RNTCP will be essential to control TB and convincingly document it.

References

1. Yadav R, Rao VG, Bhat J, Gopi PG, Wares DF. Annual risk of tuberculosis infection among tribal children of Jhabua, Madhya Pradesh. Indian Pediatr. 2011;48:43-5.

2. Vashishtha VM, John TJ. Prevalence of Mycobacterium tuberculosis infection in children in western Uttar Pradesh. Indian Pediatr. 2010;47:97-100.

3. John TJ, Vashishtha VM, John SM, Sudarshanam TD. Tuberculosis control must be scientifically defined and soundly designed. Indian J Med Res. 2010;132:4-8.

4. John TJ. Tuberculosis control, without protection from BCG. Indian Pediatr. 2000;37:9-18.

5. http://www.tbcindia.org/perfor.asp. Accessed on 29 January, 2011.
 

 

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