16.3 IPT in children

16.3.1 Newborn infants of mothers with active tuberculosis

IPT is administered to the child for 6 months. BCG vaccination is done just after IPT (BCG vaccine should not be given during isoniazid administration).

– If a child immediately or subsequently presents signs of TB, which is generally only evident after approximately 2 to 8 weeks, he should undergo complete anti-TB treatment after exclusion of other possible medical causes. This case scenario is unlikely if IPT is correctly administered, but it is not impossible in cases of primary resistance to isoniazid.

– If a tuberculin skin test (TST) is possible, the approach is:
• To administer isoniazid for 3 months, then do a TST;
• If the TST is positive, continue isoniazid for 3 more months;
• If the TST is negative, stop isoniazid and administer the BCG vaccine.

Notes:
– The child should not be separated from her/his mother unless she is severely ill. Breastfeeding should continue.
– It is possible that isoniazid is not effective if primary resistance against this drug exists (varies according to the area) or if there is a problem of secondary resistance in the mother. The child must therefore be closely monitored in all cases.

16.3.2 Children under five years of age in contact with a TB patient

See Diagnosis of tuberculosis in children, Chapter 5.

If the child presents no cough, no fever and no weight loss (failure to thrive), then administer IPT for 6 months, regardless of the vaccination status of the child. If it is not possible to administer IPT, vaccinate if not vaccinated and monitor the child.