Childhood tuberculosis: clinical research needs

Childhood tuberculosis (TB) is common in the developing world, where over 90% of global TB cases occur, and has increased in human immunodeficiency virus (HIV) endemic regions. Most children with TB are not infectious, and so, from a public health perspective, are not afforded the same priority by TB control programmes as older age groups in settings of limited resources. In addition, the diagnosis of pulmonary TB is particularly difficult in young children. This has resulted in TB being a neglected disease in children, although it causes substantial morbidity and mortality. This review summarises the current knowledge of clinical aspects of childhood TB management, and aims to identify priority areas for future research. The most critical need is for improved capability to confirm diagnosis. This would lead to better management of childhood TB and would greatly enhance our ability to conduct meaningful research in many related areas, including immunological studies which could lead to a more effective vaccine. Also important are a better understanding of risk factors for infection and disease, including the impact of HIV, and operational research to improve treatment outcomes and management of well childhood contacts.