WHO Consolidated guidelines on TB: Module 5: Management of tuberculosis in children and adolescents

The Cochrane Review ‘Xpert MTB/RIF Ultra assays for tuberculosis disease and rifampicin resistance in children' informed the WHO Consolidated guidelines on TB: Module 5: Management of tuberculosis in children and adolescents. The accompanying WHO operational handbook was published in March 2022.

Overview

The Updated guidelines on Management of tuberculosis in children and adolescents include new recommendations that cover diagnostic approaches for tuberculosis (TB), shorter treatment for children with non-severe drug-susceptible TB, a new option for the treatment of TB meningitis, the use of bedaquiline and delamanid in young children with multidrug- and rifampicin-resistant TB and decentralized and family-centred, integrated models of care for TB case detection and prevention in children and adolescents.

The desired impact of WHO normative guidance on the management of TB in children and adolescents is a reduction in the burden of TB morbidity and mortality in children and adolescents, in line with the targets included in the WHO End TB Strategy, goal 3 of the United Nations Sustainable Development Goals and the Political Declaration of the United Nations General Assembly High-level Meeting on the Fight against Tuberculosis.

The consolidated guidelines are being released as part of a modular series of WHO guidance on TB and are accompanied by a complementary operational handbook. The new recommendations are also available on the WHO Global Tuberculosis Programme’s Knowledge Sharing Platform.

TB is a preventable and curable disease, but it continues to impact the lives and development of millions of children and adolescents. Children and young adolescents aged under 15 years represent about 11% of all people with TB globally. This means 1.1 million children and young adolescents aged under 15 years fall ill with TB every year, and more than 225 000 of them lose their lives.

Since the publication of the WHO Guidance for national tuberculosis programmes on the management of tuberculosis in children – second edition in 2014, new recommendations have been published in WHO guidelines and other policy documents on TB prevention, screening, diagnosis, treatment, management and models of care. Many of these recommendations are also applicable to children and adolescents. In addition, new evidence related to the management of TB in children and adolescents became available to WHO in 2021, including data from a randomized controlled trial on treatment shortening for children with non-severe TB. Therefore, in 2021, WHO convened a Guideline Development Group (GDG) to review new evidence on the management of TB in children and adolescents. This guideline update includes new recommendations that were issued at the GDG meeting in May-June 20201 as well as recommendations from other WHO guidelines that are relevant to the management of TB in children and adolescents (including those that are in the previous guidelines on the management of TB in children that have been validated).