Multidrug-resistant tuberculosis in children and adolescents in the WHO European Region: Expert opinion.

Historically, children and adolescents have not been a priority for national programmes for tuberculosis (TB) prevention and care in the WHO European Region. Owing to the low incidence in the Region and the non-specific clinical symptoms of TB infection and disease, children with TB or at risk thereof do not routinely enter health systems through classical TB programmes. Children and adolescents were often thought to play only a minor role in transmission of TB, and as a result TB prevention and care was focussed on adults. However, children and adolescents are significantly affected by the epidemic of multidrug-resistant TB (MDR-TB) as the Region carries 25% of the global MDR-TB burden. The estimated number of children with MDR-TB in the Region was 2120 in 2016, 16% of the total incident cases, and an estimated 14.1% of latently infected children carry MDR-TB organisms. Evidence-based guidance on how to manage children and adolescents infected with or having active MDR-TB is needed. The aim of this publication is to guide Member States in the WHO European Region to adequately address child and adolescent MDR-TB at the highest level and quality. It intends to update readers on recent scientific evidence, as well as providing region-specific clinical and public health recommendations on child and adolescent MDR-TB. Resources are provided for national TB programme managers and clinicians to encourage all involved in TB prevention and care to seek expert advice for difficult-to-treat cases from their colleagues in the Region. The specific aspects of MDR-TB in children and adolescents in the Region are also discussed. Most countries of the Region have a low incidence of childhood TB but carry a large burden of MDR-TB cases. Health-care providers involved in child health should be sensitized to TB and its clinical presentation. The regionwide epidemiology of MDR-TB among children and adolescents is summarized and it is underlined that accurate reporting and notification