Tuberculosis Preventive Therapy

(TPT) for Children :

Shorter Regimen Options

Finny Fitry Yani

RSUP.Dr. M.Djamil/FK Unand - UKK Respirologi Anak IDAI
Webinar IDAI- 7 Oktober 2020
 Dr. dr. Finny Fitry Yani SpA(K)
Education

• Medical Doctor, University of Andalas, 1992

• Pediatrician, University of Andalas, 2004
• Fellowship Training FKUI/RSCM, 2006
Current position • Respirology Pediatric Consultant : 2011
• Doctoral, 2017

•Academic Staff, Department of Child Health, Faculty of Medicine University of Andalas

/M.Djamil Hospital, Padang 2004
•Member of Indonesian Pediatrics College 2004
•Committee of Respirology Coordination Working Unit – Indonesian Pediatrics Society 2007
•Member of Pediatric TB Working Group – MOH 2010
•Executive Secretary of JetSet TB Indonesia – MOH 2017
•Expert TB Panel MOH 2020
 What this talk will cover:

The Rationale of TPT among childhood TB contact

Identify, Rule out TB disease & Testing

Treatment Option & How

Role of pediatrician in National Programatic of TPT

The Terms
• IPT = Isoniazid Preventive Therapy = IPT
= Pengobatan Pencegahan dengan INH = PP INH
• TPT = Tuberculosis Preventive Therapy = TPT
= Terapi Pencegahan tuberkulosis = TPT
• Pencegahan yang dimaksud, pada individu kontak :
- pencegahan terhadap berkembangnya infeksi TB
- pencegahan terhadap berkembangnya penyakit TB
 What this talk will cover:

The Rationale of TPT among childhood TB contact

Identify, Rule out TB disease & Testing

Treatment Option & How

Role of pediatrician in National Programatic of TPT

Clinical perspective of TPT
S76 C.M. Perez-Velez et al.

Perez-Velez, 2017
Figure 1 Radiological patterns observed with intrathoracic tuberculosis in children. (Adapted from Roya-Pabon et al.48). Original
sketches by C.L. Roya-Pabon; finished artwork by Mesa Schumacher (used with permission). Panel A. Primary Ghon focus with
uncomplicated lymph node disease. Shows hilar and mediastinal lymphadenopathy associated with an ipsilateral peripheral nodule,
or “Ghon focus” (right lung); these nodules are often subpleural with an overlying pleural reaction. Panel B. Progressive Ghon
focus with uncomplicated lymph node disease. Shows a Ghon focus with cavitation (right lung), which is seen almost exclusively in
 is therefore similar to that in children under 2 years of
6 B
age and include any infection, recent or past, primary ho
or reinfection (Table 5). ve
Drain et al. Two major
Clinical challenges
Microbiology Reviews emerge regarding the diag- L
nosis of tuberculosis in childhood. The first challenge 7 D
T
is to identify any untreated infection (recent or past,
8 L
primary or reinfection), with a high degree of sensitiv- N
ity and specificity in immune-compromised children. 9 M
In immune-competent children, a positive TST under L
2 years of age or TST conversion after 10 years of age 58
indicate a high risk for disease progression and a need 10 H
di
for intervention. The second challenge is to identify be
symptomatic disease as early as possible, especially 11 D
in immune-competent children over 3 years of age. In 20
this group the onset of clinical symptoms allows the 12 E
differentiation between self-contained infection and in
gi
13 St
C
FIG 1 Pathways of tuberculosis disease progression. After initial exposure, M. tuberculosis may be eliminated by the host immune
14 O
response, persist as a latent infection, or progress to primary active disease. Following the establishment of latent infection, disease may si

Role of TPT on TB Progression

persist in a latent form, naturally progress in a slow or rapid fashion to active tuberculosis, or cycle through incipient and subclinical states 15 St
before developing into symptomatic disease or eventual disease resolution. Although not all possibilities for regression of disease burden
are depicted, spontaneous recovery may occur in any of these clinical trajectories. D
16 C
be
17 C
BACTERIAL PATHOGENESIS AND IMMUNE RESPONSE
ne
Pathogenesis of Incipient and Subclinical Tuberculosis
de
M. tuberculosis exerts a wide spectrum of infectious pathophysiology. Evidence is
18 C
mounting that genetic and phenotypic variation of the bacteria, along with the
de
interaction between these bacteria and their individual hosts, can influence the pro-
gression of TB. To our knowledge, very few studies have focused specifically on the
Figure 2 Defining the breakpoint of clinical relevance in child- cu
Pathway through TB exposure, infection & disease
Childhood TB Roadmap 2018

Background
• Over 50% of the estimated number of tuberculosis cases in
children 0-14 years (~ 1 Million) are not reported (~70% of under 5)
Terpapar TB Infeksi TB/TB Laten Sakit TB
• 80% of the TB deaths in children occur in children under 5
• While contact investigation and preventive therapy is strongly
recommended for children under 5, over 75% of eligible children
still do not access preventive therapy
• Following a workshop organized by The Union in 2014 with
national TB programs (NTP) and paediatricians from 10 countries in
francophone Africa, implementation of contact investigation and
preventive therapy was selected as a priority action
Risk of active TB disease according to age
 Epidemiological Perspective :
TB in children is of importance in TB control program
• The burden of TB in children is an important indicator of
ongoing transmission within the community
à TB in children is common wherever TB is common in adults

• Children with latent TB infection à potential source cases in the

future

• TB is an important cause of illness and death in children in many

TB endemic countries
TPT contribution to the End TB Strategy targets

TB incidence (cases per million pop. per year)

Baseline
1000
Mitigate risk factors

Prevent infection

100 Treat active TB

Treat latent TB
10

End TB Strategy : -90% by 2035

Treat active and latent TB

2000 2010 2020 2030 2040 2050

Dye C et al., Prospects for Tuberculosis Elimination. Ann Rev Public Health 2013. 34:271-86
 Evidences for efficacy of TPT
• Jaganath et al. CID 2013 Uganda
• 761 children contacts, 50% less than 5 year of age
• 10% had active TB (16% in < 5 y), among which 71% were Cu+
• Egere et a. IJTLD 2017 Gambia
• 4042 children <15 y investigated, 16% had TST > 10 mm
• 1.6% had active TB : 78 % from the household, 22% from the compound
• 7/27 asymptomatic children with TST + had bacteriologically confirmerd TB
• Shah NS, et al (2014)
• Meta-analysis of 25 studies, 47.2% of contacts had LTBI
• 7.8% of household contacts of MDR-TB patients developed TB, with most occurring within 3
years after enrolment.
 What this talk will cover:

The Rationale of TPT among childhood TB contact

Identify, Rule out TB disease & Testing

Treatment Option & How

Role of pediatrician in National Programatic of TPT

Identify who have risk?
Person Living with HIV (ODHA)

•Adults and adolescents (>10y)

•Infants aged < 12 months who are in contact
with TB*
•Children aged ≥ 12 months in a high TB
transmission setting

•All children who successfully completed

treatment for TB disease
 Who should be identify have risk?
• Kontak serumah dengan pasien TBC paru yang terkonfirmasi bakteriologis
• Anak usia di bawah 5 tahun
• Anak usia 5-14 tahun (bertahap pada program)
• Remaja dan dewasa (usia di atas 15 tahun) (bertahap pada program)
• Kelompok risiko tinggi lainnya dengan HIV negatif
• Pasien immunokompremais lainnya (Pasien yang menjalani pengobatan
kanker, pasien yang mendapatkan perawatan dialisis, pasien yang mendapat
kortikosteroid jangka panjang, pasien yang sedang persiapan transplantasi
organ, dll).
• Warga Binaan Pemasyarakatan (WBP), petugas kesehatan, sekolah berasrama,
barak militer, pengguna narkoba suntik.
 Ruling out TB disease
• Pastikan ada gejala TB atau tidak
• Gejala batuk berulang, demam, BB turun, keringat
malam, sebaiknya evaluasi adanya TB aktif.

• Pada ODHA dan kontak anak usia dibawah 5 tahun pemberian TPT
dapat dilakukan dengan skrining gejala TBC tanpa harus dilakukan
pemeriksaan TST atau IGRA maupun rontgen thorax.
• Pada kontak usia ≥ 5 tahun perlu dilakukan pemeriksaan
penunjang seperti rontgen thorax untuk menyingkirkan TBC aktif
(waspada TB Sub Klinis)
Fig. 4.1: Algorithm for TB screening and TPT

HIV positive Household contact Other risk group3

Any symptom1 of current Symptomatic?2

cough or fever or weight loss
or night sweats

YES NO

<5 years 5 years +

NO YES

Investigate for active TB

TST or IGRA

No active TB
Preventive treatment
contraindicated?4 Positive or unavailable Negative

Abnormal

Chest radiography 6
YES NO
Normal or
unavailable

Defer preventive Give preventive

treatment treatment5

Follow up for active TB as necessary, even for patients who have completed preventive treatment
 yang berisiko

Alur Penapisan
TB untuk TPT
 • Either a TST or IGRA
Test for TB infection (QuantiFERON®-TB Gold
and T-SPOT®.TB) can be
used to test for TB infection

• A test for TB infection is not

a requirement for initiating
TPT in PLHIV or individuals
aged < 5 years in contact
with people with active TB
 Tuberculin skin test IGRAs : Intereferon Gama
(TST)

• Electronic results (straight to EMR)

• Manual placement, reading and • Results with one patient visit
data entry
• Two patient visits required, high
• Objective test
no-show rate • Mitogen and nil controls
• Subjective test • CD8 T cell response can be quantified
• No controls • Provides broader picture of the immune
• Poor surveillance tool response
• Poor specificity (BCG and NTM • Highly specific, not affected by BCG
impact)

Title, Location, Date

 What this talk will cover:

The Rationale of TPT among childhood TB contact

Testing & rule out TB disease

Treatment Option & How

Role of pediatrician in National Programatic of TPT

2020 TPT guidelines – TPT options

6H • 6 or 9 months of daily isoniazid*

3HP • 3 month regimen of weekly rifapentine plus isoniazid*
3RH • 3 month regimen of daily isoniazid plus rifampicin*
• 1 month regimen of daily isoniazid plus rifapentine
• 4 months of daily rifampicin alone ( 4R )
• 36 months of daily isoniazid preventive treatment in
PLHIV >10y in settings with high TB transmission
* Strong recommendation
Paduan 6 H
• Dosis INH usia < 10 tahun 10mg/kg BB/hari, usia ≥ 10 tahun 5mg/kg
BB/hari (maksimal 300 mg/hari), plus vit B6 pada gizi buruk
• Dosis obat di sesuaikan dengan kenaikan berat badan setiap bulan.
• Obat di konsumsi satu kali sehari, saat perut kosong
• Lama pemberian 6 bulan (1 bulan = 30 hari pengobatan atau
diberikan sebanyak 180 dosis),kecuali jika muncul gejala TB -> OAT
• Obat tetap diberikan selama 6 bulan walaupun kasus indeks
meninggal, pindah atau terkonfirmasi bakteriologisnya atau BTA nya
sudah menjadi negatif.
A Prospective Evaluation of the Symptom-Based 6H
Screening Approach to the Management of
Children Who Are Contacts of Tuberculosis Cases
Rina Triasih,1,2 Colin F. Robertson,3,4 Trevor Duke,2,4 and Stephen M. Graham2,4,5
1

Results :
Department of Pediatrics, Dr Sardjito Hospital and Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia; 2Centre for International Child
Health, University of Melbourne Department of Paediatrics, 3Department of Respiratory Medicine, and 4Murdoch Childrens Research Institute, Royal
Children’s Hospital, Melbourne, Australia; and 5International Union Against Tuberculosis and Lung Disease, Paris, France

Downloaded from http://cid.oxfordjournals.org/ at Gadjah Mada University on June 11, 2015

After 12 months of follow-up, none of
(See the Editorial Commentary by Jeena on pages 19–20.)

Background. Child tuberculosis contact screening and management can enhance case finding and prevent tu-
berculosis disease. It is universally recommended but rarely implemented in tuberculosis-endemic settings. The
World Health Organization (WHO)–recommended symptom-based screening approach could improve implemen-
the 99 eligible young child contacts (<5
tation but has not been prospectively evaluated.
Methods. We conducted a cohort study of children who were close contacts of pulmonary tuberculosis patients
years) who received isoniazid
in Indonesia from August 2010 to December 2012. We performed clinical assessment, tuberculin skin test, and chest
radiography in all eligible children irrespective of symptoms at baseline. Mycobacterial culture and Xpert MTB/RIF preventive therapy (IPT) had developed
disease compared with 4 of 149 (2.6%)
assay were performed on sputum from children with persistent symptoms of suspected tuberculosis. Children were
managed according to WHO guidelines and were prospectively followed for 12 months.
Results. A total of 269 child contacts of 140 index cases were evaluated. At baseline, 21 (8%) children had tu-
berculosis diagnosed clinically; an additional 102 (38%) had evidence of infection without disease. Of children with
any tuberculosis-related symptoms at baseline, 21% had tuberculosis diagnosed compared with none of the asymp-
asymptomatic older children who did
tomatic children (P < .001). After 12 months of follow-up, none of the 99 eligible young child contacts (<5 years) who
received isoniazid preventive therapy (IPT) had developed disease compared with 4 of 149 (2.6%) asymptomatic
older children who did not receive IPT.
not receive IPT.
Conclusions. Symptom-based screening is an effective and simple approach to child tuberculosis contact man-
agement that can be implemented at the primary healthcare level.

Downloaded from http

Triasih, 2014, Indonesia
Keywords. tuberculosis; child; contact screening; preventive therapy.

Tuberculosis is a global public health challenge, with es- M. tuberculosis is common [2, 3]. It has been recognized
timates that approximately one-third of the world’s pop- that infants and young children infected with M. tuber-
ulation is infected with Mycobacterium tuberculosis [1]. culosis following exposure are at a high risk of developing
 Dosis INH dan Rifapentine berdasarkan usia dan berat badan
(dapat dilihat pada tabel.5 Karakteristik Paduan TPT pada Orang
dengan ILTB).
Paduan HP = INHPemberian
+ Rifapentine
dosis 3HP sebagai berikut :
Paduan 3HP : pada usia Tabel 4 Pemberian Dosis 3HP
mulai ≥2 tahun. Usia 2-14 tahun
Sediaan Obat 10-15 kg 16-23 kg 24-30 kg 31-34 kg
Anak berusia < 2 tahun dan INH 100 mg (tablet) 3 5 6 7 7
ibu hamil : lack of evidence Rifapentine 150 mg 2 3 4 5 5
(tablet)

Dosis INH maksimal 900 Sediaan Obat 30-35 kg 36-45 kg 46-55 kg 56-70 kg
mg/hari, dosis Rifapentine INH 100 mg (tablet) 3 3 3 3 3
maksimal 900 mg/hari, plus Rifapentine 150 mg 6 6 6 6 6
(tablet)
vit B6 pada gizi buruk

Lama 3 bulan = 3 x 4 KEMENTERIAN KESEHATAN REPUBLIK INDONESIA TAHUN 2020 19

minggu = 12 dosis dosis
3 HP : 1 weekly
PREVENT TB Study

3 HP 1 weekly vs 9 H
IMPAACT4TB Study

Tymothy,,
Paduan 3 HR
• Dosis INH usia < 10 tahun 10mg/kg BB/hari (maksimal 300 mg/ hari)
dan dosis R usia <10 tahun 15kg/mg BB/hari (maksimal 600 mg/hari)
• Dosis INH usia ≥ 10 tahun 5mg/kg BB/hari (maksimal 300 mg/hari)
dan dosis R usia ≥ 10 tahun 10 mg/kg BB/hari
• Dosis obat di sesuaikan dengan kenaikan berat badan setiap bulan.
• Obat dikonsumsi satu kali sehari, sebaiknya pada waktu yang sama
saat perut kosong
• Lama pemberian 3 bulan (1 bulan = 28 hari pengobatan atau
diberikan sebanyak 84 dosis),
 Paduan lain : 4RIF vs 9H : Indonesia data
• Dua komponen:
• Dewasa: Uji klinis fase 3 (efikasi)
• Anak: Uji klinis fase 2 (keamanan)
• Penelitian multisenter:
• Principal investigator: Prof. Richard
Menzies, MD, McGill University, Montreal,
Kanada
• Pusat-pusat penelitian: Arab Saudi,
Australia, Benin, Brazil, Ghana, Guinea,
Indonesia, Kanada, Korea Selatan
• Indonesia – Kota Bandung:
• Principal investigator: Prof. Rovina Ruslami,
dr, SpPD, PhD

Menzies, Ruslami, 2018, Indonesia

Paduan 1 HP (next year?)
• 1HP merupakan kombinasi INH dan Rifapentine yang
dikonsumsi setiap hari selama satu bulan.
• Paduan ini hanya diberikan untuk kategori umur ≥ 13 tahun.
• Dosis pemberian 1HP adalah isoniazid 300mg dan rifapentine
600mg untuk semua BB.
 Tujuan pemberian TPT adalah untuk mencegah terjadinya sakit
TBC sehingga dapat menurunkan beban TBC. Saat ini terdapat
beberapa pilihan paduan TPT yang direkomendasikan program
Bagaimana memilih paduan TPT ?
penanggulangan tuberkulosis nasional yaitu:
Tabel 3. Pilihan Paduan TPT
No Sasaran Plihan paduan TPT
3HP 3HR 6H
1 Kontak serumah usia < 2 tahun *)
2 Kontak serumah usia 2 – 4 tahun
3
4 ODHA usia < 2 tahun *)
5 )

6 Kelompok risiko lainnya

Keterangan:
*)
Bila 3HR belum tersedia maka dapat menggunakan pilihan
Efek Samping
• Mual muntah, tampak
kuning, dan gatal gatal, dll.
• Periksa apakah ada tanda
tanda efek samping seperti
ikterik, pembesaran hepar,
ruam di kulit.
Pemantauan
• Kontrol tiap bulan
• Evaluasi adanya gejala TB
• Kepastian dan kepatuhan minum
obat
• Komitmen dengan orang tua
Tatalaksana Obat terlewat
• 3 HR & 6H : < 2minggu à lanjutkan, > 2 minggu à jika 80% >
lanjutkan, jika <80% +33% lama, jika tidak à ulang dari awal

• 3 HP : 2 hari miss à lanjutkan

> 2 hari miss à lanjutkan, obah jadwal
Prinsip : hindari 2 dosis dalam jarak 4 hari
• Dosis 1-3 minggu lewat à lanjutkan, jika 4 minggu > à stop, ganti
regimen harian
Another important problems

TPT for MDR TB contacts

 Drug resistant TB in children
An estimated
251 000
children were with DR TB in
2014

Less than
10%
were diagnosed and got
access to treatment
Source of picture: artwolfe.com
 PHOENIx
TB-CHAMP V-QUIN
A5300/I2003
Intervention LVF (novel paediatric LVF vs. placebo daily for DLM vs standard dose
dispersible formulation) 6 months INH daily for 26 weeks
vs. placebo daily for 6
months

Design Cluster randomized; Cluster randomized; Cluster randomized;

superiority superiority superiority
Community-based Community-based Community-based
Target Population • 0-5 y regardless of • All ages • HIV +
TST or HIV status • Paediatric enrolment • Children 0-5 yrs
currently on hold • TST/IGRA + > 5 y
• TST +

Assumptions LVF decreases TB LVF decreases TB DLM decreases TB

incidence from 7 to 3.5% incidence by 70% from incidence by 50% from
80% power 3% untreated 5% to 2.5%
80% power 90% power
Sample size 778 Households 1326 Households 1726 Households
1556 contacts 2785 contacts 3452 contacts
Sites South Africa: DTTC, Viet Nam ACTG & IMPAACT sites MDR-TB preventiv
Matlsosana, THINK, NTP N=20-15 considerati
Shandukani
HS Schaaf
Timelines to open Q4 2016 (PK lead-in) Open (Q1 2016) Q4 2017 Desmond Tutu TB
Department of Paediatrics a
Stellenbosch Univ
TPT for child MDR TB contact in Indonesia
• July 2018 : WS & DR-TB meeting approved to Levofloxacin &
Ethambutol for 6 months
• Not well socialization & implementation until now
• Still lack & barrier in logistic
• Not yet special recording & reporting
• Don’t know about efficacy & safety
Algoritma Kontak TB RO
B. Alur penapisan TB RO dan pemberian TPT pada kontak TB RO

Kontak dengan kasus Gambar Alur Skrining

indeks TB RO pada kontak TB RO di Fasyankes

Dokter di Fasyankes:
Anamnesis & PF

Ada gejala TB Tidak ada gejala TB

Usia < 5 tahun dan atau

Usia >5 tahun
imunokompromis

Fasilitas Ro thorak Fasilitas Ro thorak

tidak tersedia tersedia

TST TST & Ro thorak

Foto thorak Foto thorak

normal sugestif TB

TST (+) TST (-) TST (+) TST (-) TST (+)/(-)

TPT TPT Observasi TPT Observasi Periksa TCM

Pemeriksaan TB RO TCM (-), TST (+) TCM (-), TST (- TCM (+), TST (+)/(-)
Sesuai Alur ) (TBC RO atau TBC SO)

TPT Observasi
Obati sesuai
Jika timbul gejala TB selama observasi atau pemberian TPT panduan
 makan. Selama pemberian obat, dilakukan pemantauan berkala terhadap munculnya
gejala TB atau keluhan efek samping obat.

Jika hasil uji kepekaan kasus indeks resisten fluorokuinolon, paduan Levofoloksasin dan

TPT TB RO
Ethambutol sebagai TPT tidak bisa diberikan. Paduan TPT akan ditentukan oleh TAK
sesuai dengan hasil uji kepekaan kasus indeks.

• No• Nama obat • Dosis • Lama • Efek Samping yang dipantau

(mg/kg/hari)
• 1. • Levofloksasin 15-20 • 6 bulan • gangguan saluran cerna,
gangguan irama jantung, sakit
kepala, dll
• 2. • Ethambutol 15-25 • 6 bulan • gangguan fungsi hati, nyeri perut,
gangguan penglihatan, dll

Beberapa kondisi yang perlu diperhatikan selama pemberian TPT pada kontak TB RO
adalah :
• Harus selalu diberikan penjelasan kepada pasien atau orang tua pasien sebelum
pemberian TPT, dan mintakan persetujuan setelah penjelasan tersebut.
• Observasi gejala klinis yang cermat dan pemantauan berkala terhadap gejala sakit
Pemantauan TPT TB RO
• Harus selalu diberikan penjelasan kepada pasien atau orang tua
pasien sebelum pemberian TPT, dan mintakan persetujuan setelah
penjelasan tersebut.
• Observasi gejala klinis yang cermat dan pemantauan berkala terhadap
gejala sakit TB minimal selama 2 tahun, walaupun telah diberikan TPT.
• Jika timbul gejala TB selama pemberian TPT, segera lakukan
pemeriksaan untuk menentukan ada tidaknya sakit TB.
• Pantau dengan ketat efek samping pemberian obat TPT.
 What this talk will cover:

The Rationale of TPT among childhood TB contact

Identify, Rule out TB disease & Testing

Treatment Option & How

Role of pediatrician in National Programatic of TPT

 TB is an important cause of illness & death
in children in many TB endemic countries
45%
2018 were notified to
National TB Programs
1.12 million
Children (0-14 yrs) infected
with TB per year

(Dod et al., 2014)

47% 205,000
Deaths
The prevention gap

Globally in 2018, In 2018, 72.5% of almost

1.3 million eligible contacts aged <5 years
did NOT access TB preventive treatment
(TPT)
Indonesia
Child TB
Performance
Pencapaian TPT
2019-2020
 TB prevention therapy among child contacts
in Indonesia
The number of child contacts
Coverage of IPT (aged < 5 yrs) received IPT
8.675
7,7%
7.224
5,9% 6.082
5,2%

2,1% 0,20% 1.147

294

2016 2017 2018 2019 Tw 1 2020 2016 2017 2018 2019 TW 1

Courtesy NTP Indonesia 2020
TPT Target on NSP TB
 Challenges in TB preventive treatment

Identification of child
Notifikasi
contacts
kasus TB
Identification of anak & TPT
Contact investigation
eligible child contacts
for TPT

Initiation of TPT

Completion of TPT Adherence

 Subdit TB
Kemenkes
+4000
Wasor TB Dokter Spesialis Anak di
Dinkes Prov Indonesia

Wasor TB RSUP/Konsultan
Dinkes Kab Kota
RSUD/RS
Swasta/SpA
Petugas TB Puskesmas/GP
Puskesmas

Peran Dokter Spesialis Anak di Indonesia

dalam Program TB anak
 Ilustrasi Target NTP
TB anak 70.000 / th
• Jika setiap bulan 4000 SpA se Indonesia menangani : TPT 900 rb/th 2024
• - 1 kasus TB anak baru = 4000 kasus TB anak / bulan
• - 1 kasus TPT anak baru = 4000 anak diberi TPT / bulan
•
Dilaporkan /
Kasus TB anak : 48.000 / tahun
Notifikasi ke
Dinkes Kasus TPT anak 48.000 / tahun
Our action now, save our generation in the future
BCG

Investigasi Kontak, Sehat/infeksi Laten TB

Kasus TB BTA
TPT Sakit TB
positif baru

2021 2050

Sakit TB Berat
Prevalens TB Eliminasi TB 2030
& Eradikasi TB
menurun
2020 2050
50
5
1

Final remarks
• Pemberian TPT pada anak kontak TB SO
dan TB RO sangat penting
• Penting memastikan anak yang diberi TPT
tidak kondisi TB aktif
• Ada beberapa pilihan regimen TPT, yang
direkomendasikan saat ini regimen 3 HP,
namun 6 H , 3 HR tetap dapat digunakan
• Peran SpA dalam program TPT dan TB
anak sangat penting
 If not you or me, who will take responsibility?

Let’s not take our eye off the ball!

https://www.nytimes.com/2020/08/03/health/coronavirus-tuberculosis-aids-malaria.html
Courtesy Prof Kawamura Slide
THANK YOU