QuestionsQuestions (LEB MEMORANDUM ORDER NO. 13, S. 2018)
It provides standard policy guidelines for casefinding, diagnosis, treatment, contact tracing, and preventive therapy (IPT) for tuberculosis among children 0–14 years old, and applies to all health facilities, agencies, and organizations implementing TB control programs in children.
When the child presents to a health facility with signs/symptoms of TB and/or when the child is a close contact of a known TB case.
A person living in the same household as or in frequent contact with a source case.
A child is TB symptomatic if with any three (3) of the listed signs/symptoms, including: cough/wheezing of 2 weeks or more; unexplained fever of 2 weeks or more; weight faltering/loss of weight or appetite; failure to respond to 2 weeks of appropriate antibiotics for lower respiratory tract infection; failure to regain previous health 2 weeks after viral infection/exanthema (e.g., measles); fatigue/reduced playfulness/lethargy.
Examples include: gibbus (especially of recent onset) and non-painful enlarged cervical lymphadenopathy with fistula formation.
Use the Mantoux method with 2 TU PPD (PPD-R/T 23) or 5 TU PPD-S if the former is not available. A positive TST is induration of 10mm or more read between 48 and 72 hours after injection, regardless of BCG vaccination status.
Only trained health worker shall do tuberculin testing and reading.
No. The guidelines expressly state that a trial of anti-TB medicines shall not be used as a method of diagnosing TB in children.
Among younger children (5–9 years) who can expectorate, and children (10–14 years) who have cough for 2 weeks. If DSSM is positive, treatment is started immediately and TST is no longer performed.
Generally no. CXR shall not be used alone in the diagnosis of childhood pulmonary TB unless the finding is miliary tuberculosis.
It reviews smear-negative cases with CXR suggestive of pulmonary TB, composed of NTP medical/nurse coordinators, a radiologist, and a clinician (internist or pulmonologist). The evaluation result must be available within 2 weeks to minimize delay in diagnosis and treatment.
Serological tests, nucleic acid amplification (e.g., PCR), computerized chest tomography, and bronchoscopy can be used but are not currently recommended for routine diagnosis of TB in children.
Directly Observed Treatment (DOT) shall be followed for all children undergoing therapy.
Hospitalization is warranted initially for severe forms when possible, including: TB meningitis and miliary TB, respiratory distress, spinal TB, and severe adverse events such as clinical signs of hepatotoxicity (e.g., jaundice).
Treatment shall be stopped and immediate referral undertaken upon liver tenderness, hepatomegaly, or jaundice. The AO states there is no need to monitor serum liver enzyme levels routinely.
Smear-positive children should have a follow-up DSSM similar to adult cases. For extrapulmonary and most childhood TB cases, response is assessed clinically. Follow-up CXRs are not routinely required.
Age groups are divided into: (a) 0–4 years old, and (b) 5–14 years old.
Examples include: number of children screened (by age group); number treated for TB disease; proportion of all childhood TB cases by age group; proportions of pulmonary TB vs extrapulmonary TB; proportions of miliary TB and TB meningitis; cure rate (smear-positive); treatment completion rate (smear-negative pulmonary/extrapulmonary); number given IPT and its outcome including completion.
BCG vaccination shall be given to all infants to prevent severe types of TB, following EPI policies and procedures. Revaccination of BCG is not recommended.