Survey result overview: Inventory on policy and …...Introduction Survey conducted as per recommendation of last Wolfheze workshop (2013) Key aim: To assess current adolescent TB

„Wolfheze“ workshop, session 7: childhood TB, The Hague, 29 May

2015

Survey result overview: Inventory on policy and practices of TB in

adolescents in the WHO European Region

© Maxim Dondiuk

Dr Martin van den Boom

WHO Regional Office for Europe

© Carl Cordonnier

© Maxim Dondiuk

© Carl Cordonnier

On behalf of the European Childhood TB

taskforce

Introduction

Survey conducted as per recommendation of last Wolfheze workshop (2013)

Key aim: To assess current adolescent TB (age 10-19 years) policy and

practices in the WHO European Region

Key aspects on TB in adolescents:

• More often symptomatic and SS+ than younger children (“entry point for

early diagnosis”), more often infectious (infection control implications)

• “Mixed” radiographic findings (adults – children)

• Group prone to treatment disruption and threat to adherence

• Social implications (i.e. as caused by disruption of schooling)

Participating Member States (28/53) (random order)

Finland

Macedonia

Denmark

Andorra

Hungary

Luxembourg

Norway

Bosnia and Herzegovina

Tajikistan

Monaco

Estonia

Greece

Georgia

Ireland

Serbia

Germany

Russian Federation

Azerbaijan

Belarus

Uzbekistan

Turkmenistan

Slovakia

Sweden

Bulgaria

Czech Republic

Ukraine

Armenia

Netherlands

Overview: Policy section

Questions Number of

countries ‘

yes’

Is it possible to retrieve any epidemiological information on TB for the age

group 10 to 19 years from national surveillance data base?

26 (93%)

Are adolescents of the age group 10-19 considered to be at increased risk of

getting TB?

7 (25%)

Need for specific guidance or guidelines on adolescent TB in your country? 8 (26%)

Are adolescents with sputum smear and culture negative drug-susceptible TB

but still on treatment allowed to attend school, higher education?

17 (61%)

Are adolescents with sputum smear and culture negative Drug-resistant-TB but

still on treatment allowed to attend to school, higher education?

15 (54%)

Alternative arrangements for schooling

In 8 countries where adolescents are not allowed/restricted to attend

school:

• School education is continued at the hospital department / hospital

premises (3x)

• Separate ‘ sanatorium schools’ where adolescents can continue

education (1x)

• Home education (1x)

• No specialized arrangements (3x)

Policy Designated specific TB policy on adolescents

Answer Number of

countries

Yes (6/28: 21%), for age group:

15 to 19 years

15 to 18 years

14 to 17 years

15 to 17 years

1

2

1

2

No (20/28: 79%)

There are guidelines which cover the age until:

14

15

16

17

18

19

5

4

4

0

6

1

Total 28 respondents

Number of

countries ‘

yes’

Adolescent TB contacts other than ‘close contacts’ targeted for contact

investigation

16/20

Are adolescents (10-19 years) given isoniazid preventive therapy (IPT)? 16/20

Is regular examination (with TST / IGRA, X-ray or fluorography) used for

detection of TB disease in asymptomatic adolescents (also called “mass”

screening)?

4/20

Adolescents on treatment for active drug-susceptible TB admitted to the hospital

for a fixed period?

8/20

Adolescents on treatment for active Drug-resistant-TB admitted to the hospital? 6/18

Asymptomatic adolescents with LTBI who have been in contact with a Drug-

resistant-TB index case given preventive therapy?

7/19

Overview: Practices section

Key challenges

• Few cases of adolescent TB may cause:

Delays in diagnosis, No expressed need for age-specific policies

• Contact investigation may be difficult due complicated social networks

• Non compliance to screening in non-accompanied ‘under-age’ immigrants

• Not all anti-TB drugs are permitted for use in adolescents

• Poor adherence to treatment

• Issues in TB care for adolescents are similar to those of the issues of

adults: perceived stigma, staff shortages

• Need for appealing communication materials on TB and LTBI targeted at

adolescents

Summary

• More than 50% of all Member States of WHO European

Region responded (similar number from low and high TB

burden backgrounds)

• All of those filled in the section on country specific challenges

• High degree of heterogeneity of answers across countries and

sections (policy and practice)

• 25% or more perceive adolescents at increased risk and need

for special guidance

Summary (II) • Epidemiological data is available at country level, could be better

utilized to get a better picture of the extent of problems in access to

diagnosis and care

• Smooth continuation of schooling and linkage with ambulatory

treatment is still not achieved in all countries

• Mass screening using TST and BCG-revaccination persist in some

countries

• Access to diagnosis and treatment does not seem to be a specific

problem in this group, although there are some concerns on treatment

adherence and ‘willingness’ to participate in active case finding and

contact investigation

Acknowledgements

To the Members and supporters of the European childhood TB taskforce,

and particularly Masoud Dara, Connie Erkens, Valentin Rusovich, Nick

Blok, Jean-Pierre Zellweger and James Seddon

Thank you very much!

[email protected]

Discussion

• Next steps?

• Need for additional/specified guidance,

epidemiological analysis?

• If so, which role should WHO and partners play?