Tuberculosis continues to be a global problem for people of all ages, but the period of adolescence and young adulthood is one where there is increased susceptibility to the disease. However, tuberculosis in this age group has been relatively unstudied.
Pediatrics is early releasing an article that does a deep dive into tuberculosis in adolescents and young adults. The article, entitled “Global Burden of Tuberculosis in Adolescents and Young Adults: 1990-2019,” by Weijing Shang, PhD, and colleagues at Peking University and Tsinghua University in Beijing, China, uses data from the Global Burden of Disease Study 2019 to understand trends in 10-24-year-olds (10.1542/peds.2023-063910).
The good news is that the incidence of tuberculosis in this age group has declined by 33% from 144.12 per 100,000 people in 1990 to 97.56 per 100,000 people in 2019, and the decline has been similar regardless of age, sex, sociodemographic factors, and country.
The bad news is that the incidence of extensively drug-resistant and multidrug-resistant tuberculosis has increased. The authors suggest that, while some of this increase may be from improved testing for drug resistance, delays in treatment, inadequate access to drugs, and the conflict inherent in clinic-based directly observed therapy where a healthcare worker watches you swallow the pills (this has been the most effective strategy for ensuring that tuberculosis medicines are taken) for those who need to also attend school or work are also potentially playing a role.
In my practice that has a high proportion of patients who have lived or recently visited other countries, we regularly screen for tuberculosis. This article emphasizes the need to continue with this regular screening, and reminds me that, if the interferon-gamma release assay (IGRA) is positive, we need to also think about the possibility of drug-resistant tuberculosis infection.
