Childhood tuberculosis—out of the shadows

Historically, childhood tuberculosis (TB) has been in the shadows, with global TB control programs focused exclusively on adults with sputum smear-positive TB [1]. This was based on a firm belief that the most cost-effective method to contain the TB epidemic and thereby benefit the whole community, including children, was to identify and treat the most infectious adult cases. The fact that this approach excluded children from treatment reflected a strict public health focus and an ignorance of the disease burden suffered by childen in settings with uncontrolled TB transmission. Luckily things have changed. Recently, the United Nations Secretary-General’s Special Envoy on TB Dr Eric Goosby stated: “Far too long, children with tuberculosis have remained in the shadows. While there have been tremendous strides made in improving other areas of child health and survival, we have yet to see the parallel advances in pediatric TB. Instead, many children with TB die before they can be diagnosed and treated” [2]