National Tuberculosis Elimination Programme (NTEP)
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Introduction
Formerly Revised National TB Control Programme (RNTCP); renamed NTEP in 2020 under National Health Mission
National Strategic Plan (NSP) 2017-2025: “TB Mukt Bharat” – TB elimination by 2025 (incidence <1/1,00,000)
Strategy: Detect – Treat – Prevent – Build (DTPB)
Paediatric TB accounts for 6–7% of total notified cases (~3.42 lakh children 0–14 years estimated annually; ~1 lakh 0–14 years + 1.4 lakh 15–18 years reported)
Burden & Challenges in Children
Higher proportion of extrapulmonary TB (EPTB) and severe disseminated forms (miliary, TB meningitis) compared to adults
Paucibacillary disease → lower yield of conventional smear microscopy
Diagnostic difficulties: Non-specific symptoms, inability to expectorate sputum, overlap with malnutrition/pneumonia
High under-diagnosis & under-reporting; significant contribution to under-5 mortality
Risk factors: Household contact, severe acute malnutrition, HIV, immunosuppression
Diagnosis
Presumptive Paediatric TB: Persistent fever/cough >2 weeks, unexplained weight loss (>5% in 3 months) or failure to gain weight, TB contact history (last 2 years)
Microbiological confirmation prioritised – Universal Drug Susceptibility Testing (U-DST)
Preferred specimens: Gastric aspirate (overnight fasting), induced sputum, sputum (older children), BAL if required
First-line test: CBNAAT (GeneXpert MTB/RIF) or Truenat for MTB detection + rifampicin resistance
Chest X-ray (frontal): Highly suggestive – hilar/mediastinal lymphadenopathy, miliary shadows, fibrocavitary lesions; non-specific findings → trial of antibiotics then re-evaluate
Supportive: TST (≥10 mm) or IGRA (not diagnostic alone)
EPTB: Site-specific (FNAC/biopsy/CSF analysis, USG/CECT/MRI as indicated)
Algorithm: Clinical suspicion → CXR → CBNAAT on appropriate sample → clinically diagnosed TB if microbiology negative but strong evidence