New study highlights the significant risk of tuberculosis among children in high-burden areas, urging immediate action to tackle this public health crisis.
A new study has uncovered a startling statistic: nearly 10% of children in high-burden tuberculosis (TB) settings develop the disease by their 10th birthday. The research, led by Boston University School of Public Health (BUSPH), the University of São Paulo and the University of Cape Town, provides crucial insights into the persistent risk of TB infection in these vulnerable populations.
Published in The Lancet Child & Adolescent Health, this pioneering study is the first to assess the incidence of TB infection and active disease in children over their first decade of life within high-burden communities. An estimated 1.2 million children contract tuberculosis annually, and 200,000 succumb to the disease worldwide. However, the dynamics of TB risk throughout childhood have remained poorly understood until now.
The research team followed a birth cohort of 1,137 pregnant women and their 1,143 children enrolled in the Drakenstein Child Health Study near Cape Town, South Africa, from 2012 to 2023. The children were tested for TB infection and disease at six months, 12 months and annually thereafter if tests remained negative. They were also tested whenever they developed lower respiratory tract infection. By eight years old, a substantial 36% of the cohort had become infected with TB.
“These results are striking and show that children in these communities in South Africa are at extraordinarily high risk,” co-senior author Leonardo Martinez, an assistant professor of epidemiology at BUSPH, said in a news release. “Perhaps 1,000 to 2,000 South African children are at greater risk of TB than their young counterparts in the United States. It’s an urgent health problem with both short and long-term impacts on these children and their families.”
The study found that new TB disease cases peaked during the first year of life and, although the risk declined as children aged, the fact that one in 10 children developed TB disease by age 10 remains deeply concerning. This high prevalence portends future health complications, potentially weakening their immune systems and leaving them more susceptible to other illnesses throughout their lives.
Despite the availability of effective TB treatments, the majority of children in the study did not receive preventive care. Many of those who developed TB disease had been diagnosed when presenting with acute pneumonia, suggesting a need for more rigorous TB screening among children with respiratory infections in high-prevalence areas.
“Despite reasonable nutrition and almost no children living with HIV, there was an extraordinarily high, concerning rate of TB infection and disease in this cohort,” co-senior author Heather Zar, principal investigator of the Drakenstein Child Health Study, said in the news release. “Many children with TB disease were diagnosed when they presented with acute pneumonia, suggesting that in areas of high TB prevalence, children with pneumonia should be investigated for TB.”
As the global community aims to meet the World Health Organization’s Sustainable Development Goals by 2030, which include reducing TB incidence by 80% and TB deaths by 90%, focusing on pediatric TB remains critical.
“If we are to reduce pediatric tuberculosis globally, a multisectoral approach is needed that brings together researchers, policymakers, health care workers, funders and advocates to find comprehensive solutions,” added Martinez.
Such cross-sector collaboration will be vital in addressing this pressing public health issue and improving outcomes for children in high-burden TB settings.