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Care priority and warning signs
Care priority
Initiate Preventive Therapy
Red flags
- Development of any symptoms or signs suggestive of active TB during follow-up.
Assessment
- Ask: Has the child had contact with a person with Pulmonary TB or chronic cough?
- Confirm Positive history of contact.
- Confirm Absence of TB symptoms: No cough ≥14d? No fever ≥14d? No poor weight gain?
- Confirm Absence of Physical signs suggestive of TB: No neck/axilla/back swelling? No stiff neck? No persistent wheeze?
- Confirm absence of positive GeneXpert/smear if done.
Classification
- Positive history of contact with a TB case AND NO other TB symptoms or signs listed -> TB EXPOSURE
Key features
- Confirmed history of contact with an infectious TB case.
- Absence of any symptoms or signs suggestive of active TB disease.
- Eligibility for Isoniazid Preventive Therapy (IPT) to prevent progression to active disease.
- HIV positive children >1 year with no symptoms/signs are also eligible for IPT even without known contact in high-burden settings (see Page 9 note).
Management
Non-pharmacological management
- Counsel caregiver on importance of completing IPT.
- Advise on monitoring for TB symptoms.
Pharmacological treatment
- Start Isoniazid Preventive Therapy (IPT): Give Isoniazid (INH) 10mg/kg once daily for 6 months.
- Weight band dosing for INH 100mg tablets (Page 19): 3-5.9kg: 1/2 tab. 6-9.9kg: 1 tab. 10-13.9kg: 1 1/2 tabs. 14-19.9kg: 2 tabs. 20-24.9kg: 2 1/2 tabs.
- If HIV positive child above 1 year with no contact history but also no symptoms/signs: Start IPT (as per page 9).
- Treat, counsel, and follow up any existing infections.
- Ask about the caregiver's health (possible source case) and link to TB services if needed.
- Link child to the nearest TB clinic for IPT monitoring/refills.
Follow-up
- Requires follow-up, often monthly at TB clinic, to monitor adherence, check for side effects, and assess for development of active TB symptoms.
- Ensure completion of the full 6-month course.
Counselling points
- Explain that the child was exposed to TB but is not sick now.
- Explain that Isoniazid medicine is given for 6 months to prevent the child from getting sick with TB.
- Teach how to give Isoniazid correctly (dose, frequency - once daily, duration - 6 months).
- Advise on potential side effects (rare in children, e.g., rash) and when to return.
- Stress the importance of completing the full 6 months.
- Advise to return immediately if the child develops cough, fever, or poor weight gain (signs of active TB).
- Ensure caregiver (source case) is receiving appropriate TB treatment.
Differential diagnosis
- TB (active disease)
- No TB / No Exposure
Complications
- Development of active TB disease if IPT is not taken or is ineffective.
- Side effects of Isoniazid (rare).
Prevention
- IPT itself is prevention.
- Early diagnosis and treatment of source case.
- BCG vaccination.
- Good nutrition and general health.
References
IMCI Chart Booklet - Page 9, Page 19/20 (IPT Dosing)