Tuberculosis in childhood and adolescence: a view from different perspectives

Objective: To describe the epidemiological situation of tuberculosis in children under 19 years of age in Brazil and to review the latest publications on disease risk, diagnosis, treatment, and prevention. Source of data: Notifiable Diseases Information System (2018), World Health Organization estimates, and PubMed articles selected using the descriptor "Tuberculosis," delimited by type of study, period, age, and language. Synthesis of data: In 2018, in Brazil, 9.4% of notifications were in children under 19 years. The pulmonary form predominated in 80.1% of the cases. The cure rate was 76.8%, lethality was 0.8%, and abandonment was 10.4%. The prevalence of drug-resistant tuberculosis (2011-2016) was 0.5%. It has been found that the risk of disease can reach up to 56% in children under 5 years, influenced by helminth co-infections, malaria, chronic viral infections, live attenuated virus vaccines, and hypovitaminosis D. Exposure to a bacilliferous patient for periods shorter than 30 minutes is sufficient for the development of infection and/or disease. In Brazil, microbiological screening is recommended, but the use of the scoring system, modified in 2019, has been maintained. Studies on infection detection have supported the use of the tuberculin skin test. In the treatment, the great advance was the introduction of dispersible formulations, adjustment of the recommended doses, and shortened regimens for latent infection. Several vaccine studies (stages 1-3) are ongoing, but no BCG-licensed substitute has been implemented yet. Conclusions: There has been progress in treatment, but major challenges need to be overcome to improve diagnosis, monitoring, and outcome of cases, aiming to eliminate tuberculosis. (C) 2019 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda.