Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
Joint TB, HIV, and Viral Hepatitis Programme, WHO Regional Office for Europe, UN City, Copenhagen, Denmark.
Int J Tuberc Lung Dis. 2022 May 1;26(5):433-440. doi: 10.5588/ijtld.21.0541.
As the WHO European Region has the highest proportion of multidrug-resistant TB (MDR-TB) among total incident TB cases, many children and adolescents are at risk of MDR-TB infection and disease. We performed an electronic survey of clinicians and TB programme personnel who attended the 2020 Regional Consultation on child and adolescent TB organised by the WHO Regional Office. We characterised access to diagnostics and drugs, and practices in the prevention and management of child and adolescent MDR-TB. Children and adolescents are inconsistently represented in national guidelines and budgets; child-friendly drug formulations for MDR-TB treatment are insufficiently available in 57% of countries, and 32% of countries reported paediatric drug stock-outs. The novel drugs, bedaquiline and delamanid, are accessible by respectively 80% and 60% of respondent countries. Respondents were asked how many children were diagnosed with MDR-TB in 2019, and a comparison of this number to modelled estimates of incidence (to identify the case detection gap) and WHO notifications (to identify the case reporting gap) showed substantial differences in both comparisons. Better representation of this patient group in guidelines and budgets, greater access to drugs and improved reporting are essential to reach TB elimination in this Region.
由于世卫组织欧洲区域在全部新增结核病病例中耐药结核病（MDR-TB）的比例最高，许多儿童和青少年面临感染和罹患耐多药结核病的风险。我们对参加世卫组织欧洲区域办事处组织的 2020 年儿童和青少年结核病区域磋商的临床医生和结核病规划人员进行了电子调查。我们对获取诊断和药物的情况以及预防和管理儿童和青少年耐多药结核病的做法进行了描述。儿童和青少年在国家指南和预算中没有得到一致体现；57%的国家缺乏儿童适用的耐多药结核病治疗药物制剂，32%的国家报告儿童药物短缺。新型药物贝达喹啉和德拉马尼在 80%和 60%的应答国中可获得。受访者被问及 2019 年有多少儿童被诊断患有耐多药结核病，并将这一数字与发病率模型估计数（确定病例检出差距）和世卫组织报告数（确定病例报告差距）进行了比较，结果表明这两个比较都存在很大差异。为了在该区域实现结核病消除，至关重要的是在指南和预算中更好地体现这一患者群体，增加药物供应并改善报告工作。
