TB Screening: Children Younger than 10 Years

Children younger than 10 years form one of the important vulnerable groups for Tuberculosis.

The vulnerable children under 10 years are categorised into the following three main categories and they are screened differently for TB (Figure).

1. HIV-positive: Screened with four-symptom complex (cough, fever, weight loss, night sweats).
2. Household contacts:
   1. Screened primarily with the presence or absence of symptoms:
      1. Cough
      2. Fever
      3. Night sweat
      4. Haemoptysis
      5. Weight loss
      6. Chest pain
      7. Shortness of breath
      8. Fatigue
      9. In children <5 years, additionally look for anorexia, failure to thrive, not eating well, decreased activity, or playfulness.
   2. If asymptomatic – Children over five years can be further screened with Tubercular Skin Tests (TST) or Interferon Gamma Release Assay (IGRA) – If positive, they can further be screened by chest X-ray.
3. Other high-risk children: Other high-risk group children including silicosis, dialysis, anti- Tumour Necrosis Factor (TNF) agent treatment, transplantation etc. should be screened by TST/ IGRA - If positive, further screening may be done using chest X-ray.

Figure: Screening Algorithm for Vulnerable Children <10 years; Source: Guidelines for Programmatic Management of TB Preventive Treatment in India, 2021.

For screening children in situations other than as part of contact investigation or screening among people living with HIV:

• Take proper history (from child or parents as the case may be) to determine if the child is HIV-positive or has had recent contact with someone who has TB.
• Apply the same algorithm options for children younger than 10 years who are living with HIV or who are contacts of someone with TB.

Resources

• Systematic Screening for Active Tuberculosis; Principles and Recommendations, WHO 2013.
• Guidelines for Programmatic Management of TB Preventive Treatment in India, 2021.

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