Paediatrics (RCH) - Research Publications
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ItemWHO consolidated guidelines on tuberculosis – tuberculosis preventive treatment.(World Health Organization, 2020)Steve Graham (Center for International Child Health University of Melbourne, Australia) was a member of the External Review Group (ERG) for the 2020 guidelines. Background: About one fourth of the world’s population is estimated to be infected with the tuberculosis (TB) bacterium, and about 5–10% of those infected develop active TB disease in their lifetime. The risk for active TB disease after infection depends on several factors, the most important being the person’s immunological status. TB preventive treatment given to people at highest risk of progressing from TB infection to disease remains a critical activity to achieve the global targets of the End TB Strategy, as reiterated by the UN High Level Meeting on TB in 2018. Delivering treatment effectively and safely necessitates a programmatic approach to implement a comprehensive package of interventions: identifying individuals at highest risk, testing for infection, excluding active TB, choosing the treatment option that is best suited to an individual, managing adverse events, supporting medication adherence and monitoring programmatic performance. The 2020 recommendations for the programmatic management of TB preventive treatment are the first to be released under the rubric of WHO consolidated TB guidelines (Module 1 – Prevention). The WHO consolidated TB guidelines will gradually group all TB recommendations and will be complemented by matching modules of a consolidated operational handbook. [1] The handbook will provide practical advice on how to put in place the recommendations at the scale needed to achieve national and global impact. The first handbook module in the series will be on the programmatic management of TB preventive treatment and will accompany the 2020 guidelines. Overview: The 18 recommendations on tuberculosis preventive treatment in the 2020 update cover critical steps in programmatic management that follow the cascade of preventive care. The main changes introduced include conditional recommendations for a 1-month daily rifapentine and isoniazid regimen and a 4-month daily rifampicin regimen as alternative treatment options in all TB burden settings. Advice on isoniazid preventive treatment in pregnancy and on the concomitant use of rifapentine and dolutegravir has been updated to reflect the findings from latest studies. The operational limitations that need to be overcome by countries to achieve global targets are highlighted and will be discussed in greater detail in the accompanying operational handbook that is being released concurrently. The guidelines are to be used primarily in national TB and HIV programmes, or their equivalents in ministries of health, and for other policy-makers working on TB and HIV and infectious diseases in public and private sectors and in the community.
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ItemMultidrug-resistant tuberculosis in children and adolescents in the WHO European Region: Expert opinion.(World Health Organization, 2019)Historically, children and adolescents have not been a priority for national programmes for tuberculosis (TB) prevention and care in the WHO European Region. Owing to the low incidence in the Region and the non-specific clinical symptoms of TB infection and disease, children with TB or at risk thereof do not routinely enter health systems through classical TB programmes. Children and adolescents were often thought to play only a minor role in transmission of TB, and as a result TB prevention and care was focussed on adults. However, children and adolescents are significantly affected by the epidemic of multidrug-resistant TB (MDR-TB) as the Region carries 25% of the global MDR-TB burden. The estimated number of children with MDR-TB in the Region was 2120 in 2016, 16% of the total incident cases, and an estimated 14.1% of latently infected children carry MDR-TB organisms. Evidence-based guidance on how to manage children and adolescents infected with or having active MDR-TB is needed. The aim of this publication is to guide Member States in the WHO European Region to adequately address child and adolescent MDR-TB at the highest level and quality. It intends to update readers on recent scientific evidence, as well as providing region-specific clinical and public health recommendations on child and adolescent MDR-TB. Resources are provided for national TB programme managers and clinicians to encourage all involved in TB prevention and care to seek expert advice for difficult-to-treat cases from their colleagues in the Region. The specific aspects of MDR-TB in children and adolescents in the Region are also discussed. Most countries of the Region have a low incidence of childhood TB but carry a large burden of MDR-TB cases. Health-care providers involved in child health should be sensitized to TB and its clinical presentation. The regionwide epidemiology of MDR-TB among children and adolescents is summarized and it is underlined that accurate reporting and notification of child and adolescent TB cases is key to successful control of the disease. An overview of the key guideline documents currently published by WHO is given, with a particular focus on how they relate to the regional response to child and adolescent TB. The latest evidence-based and WHO recommendations on diagnosis and treatment of MDR-TB are provided, together with a summary on WHO’s position on TB vaccination. There is still a need to develop national TB guidance documents dedicated to child and adolescent TB in some Member States of the Region. All measures should be integrated into the Member States’ respective national TB programmes and other health services managing children with MDR-TB or at risk thereof to meet the End TB Strategy goals as well as the related objectives laid out in the Tuberculosis Action Plan for the WHO European Region 2016–2020.
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ItemRoadmap towards ending TB in children and adolescents.(World Health Organization, 2018)
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ItemNo Preview AvailableChildhood MDR TB for healthcare workers: an online course.(IUATLD, 2016)
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ItemNo Preview AvailableChildhood TB for healthcare workers: an online course.(International Union, 2014)
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ItemNo Preview Available
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ItemNo Preview AvailableGuidance for National Tuberculosis Programmes on the management of tuberculosis in children(World Health Organization, 2006)
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ItemRoadmap for childhood tuberculosis: towards zero deaths.(World Health Organization, 2013)