Early detection of TB could save lives of 700,000 children, study finds

Analysis shows how contact tracing can improve survival rates across the world

A baby receives a Bacillus Calmette-Guerin (BCG) vaccine for tuberculosis in Banda Aceh, Indonesia. AFP

More than half a million deaths from tuberculosis could be avoided by improved contact tracing and preventive measures across Africa and Asia by 2035, a scientific study has revealed.

Analysis published in The Lancet suggests cost-effective TB treatments, combined with a strategy to identify close contacts with the disease, could cut the number of deaths by up to 35 per cent.

In 2021, 1.6 million people worldwide died from TB, an infectious bacterial disease that affects the lungs and spreads through the air when infected people cough, sneeze or spit. It usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine.

It is the 13th leading cause of death worldwide, with an estimated 10.6 million falling ill with the disease in 2021.

The study by the John Hopkins University, the Arum Institute and global health agency Unitaid, found a combination of drug treatments and contact tracing could yield an estimated 13 per cent cumulative reduction in the number of contacts developing TB, if carried out on a wide scale before 2035.

The study is the first to provide comparable evidence on the cost-effectiveness of short-course TB preventive treatment for people living with HIV and household contacts in three age groups, children under five, those aged 5-14 and teenagers of 15 and older.

The analysis was based on modelling from 29 countries representing a range of income levels, geographic regions, and HIV and TB incidence.

Nations included 17 across Africa, as well as India, Pakistan, Bangladesh, Brazil and Indonesia.

Researchers found around 700,000 lives saved would be children under 15.

Deadly disease

“Tuberculosis remains the world’s deadliest infectious disease, despite being preventable and curable,” said Gavin Churchyard, group chief executive of the Aurum Institute.

“Although progress has been made in preventing TB among people living with HIV, we’ve lagged behind in keeping family members – especially children – free of the disease when a parent becomes sick.

“This new study, we hope, provides the evidence needed to heavily scale up the use of TB preventive treatment among those individuals at risk of developing TB.”

TB preventive therapy has made enormous strides in recent years, with new, shorter treatments capable of clearing the infection before it fully develops.

Typically, those diagnosed with TB are provided with 3HP – a combination of drugs rifapentine and isoniazid, while their household members are identified, assessed, and treated if also found to be carrying the infection.

Scientists said detecting an infection early was vital to reducing deaths.

“The imperative for TB prevention is clear,” said Vincent Bretin, director of results at Unitaid. “This cost-effectiveness analysis proves that pre-emptively reaching all at-risk individuals – even when it requires the logistical hurdles of going into communities to find those who may not be actively seeking care – is not just ethically sound.

“It is a smart investment capable of making an enormous impact on the fight to end TB worldwide.”

Vulnerable children

Around 74 million lives have been saved through effective treatments and annual screening programmes this century.

But TB is becoming more resistant to drugs traditionally used to combat the disease, leaving patients with fewer options for effective treatments.

Those living with HIV and children under five are particularly vulnerable, with only 30 per cent of infants with TB diagnosed.

It is hoped better contact tracing and prevention measures could vastly reduce the number of child deaths.

“At the moment, too many family members of people diagnosed with TB are slipping through the cracks and too many lives are being lost,” said Tess Ryckman, faculty member at Johns Hopkins University and lead author of the study.

“To finally make a significant dent in the TB epidemic, we need stronger recommendations in favour of TB prevention for household contacts along with a significant boost in resources.

“The stakes are too high not to act now.”

In the UAE, all overseas residents must undergo TB screening while renewing their residence visas.

Those found with scars or active TB or found to have drug-resistant TB will be issued a “conditional fitness certificate” and be issued a one-year residence visa and have to undergo treatment.

The number of tuberculosis infections in the UAE increased by 0.1 cases per 100,000 people in 2021. In total, the number of tuberculosis infections amounted to 0.82 cases per 100,000 population in 2021.