HomeIn 2019, there were an estimated 1.2 million cases of childhood TB (defined as TB disease in those younger than 15 years old) around the globe, and TB remains a top-10 cause of childhood mortality.1 There remains a need for better resources, improved diagnostic tools, new drugs and effective vaccines. While more than 60% of all Canadian TB disease occurs among the foreign-born population, more than half of childhood TB in Canada occurs in Canadian-born Indigenous children (Table 1), although they make up less than 10% of the Canadian pediatric population.2,3 Among Indigenous children, the highest rates of TB are in the Inuit.2 Foreign-born children and the children of foreign-born parents account for the rest of pediatric cases (see Chapter 1: Epidemiology of Tuberculosis in Canada).2,4 A pediatric TB assessment should take into account the global and local epidemiology and the possibility of drug resistance, especially in foreign-born children and those who have traveled to TB endemic countries.
TB disease in children differs from that in adults in several ways: (1) diagnosis in children <10 years old may be difficult because signs and symptoms are often nonspecific; (2) TB disease is often paucibacillary; (3) TB disease in children <10 years old is often a sentinel event, indicating recent transmission; if an index case has not been identified, source case investigation is recommended for children <5 years old; (4) young children, especially infants, are at high risk of progressing from TB infection to disease, and predisposed to more severe forms of disease;5,6 and (5) treatment may be more challenging due to issues with pill swallowing, drug palatability and dose adjustments for weight gain.
This chapter will cover the most important aspects of pediatric TB and highlight the differences in diagnosis and management in children compared with adults. Readers are encouraged to refer to other chapters for more detailed information.
Table 1. Childhood TB cases in Canada, 2019 by population group.
| AGE (years) | |||||
|---|---|---|---|---|---|
| Population group | <1 | 1-4 | 5-14 | Total <15 | % of all childhood cases |
| Inuit | 4 | 9 | 22 | 35 | 31 |
| First Nations | 2 | 14 | 13 | 29 | 25 |
| Metis | 0 | 4 | 1 | 5 | 4 |
| Total Indigenous | 6 | 27 | 36 | 69 | 61 |
| Canadian-born non-Indigenous | 0 | 9 | 8 | 17 | 15 |
| Total Canadian-born | 7 | 37 | 45 | 89 | 78 |
| Foreign-born | 0 | 3 | 15 | 18 | 16 |
| Unknown origin | 1 | 2 | 4 | 7 | 6 |
| Total cases | 14 | 42 | 64 | 114 | 100 |
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