In a tuberculosis screening and treatment initiative covering the entire population of Tibetan refugee schoolchildren in northern India, a team directed by researchers at Johns Hopkins Medicine and the University of Wisconsin says it has found not only a startlingly high prevalence of TB disease and infection but also a potentially workable strategy to eliminate the disease in a large, high-risk group.

Our innovative initiative includes population-level implementation of TB preventive therapy as part of a multipronged strategy to control and eliminate TB in an at-risk population in India," says lead study author Kunchok Dorjee, Ph.D., M.B.B.S. Dorjee is a research associate at the Johns Hopkins University School of Medicine and director of the Zero TB in Tibetan Kids project an initiative implemented locally by the Delek Hospital in Tibet and the Central Tibetan Administration health and education departments.

TB Control

"With the support of local leadership and community mobilization, including support from His Holiness the Dalai Lama, we have demonstrated that TB control can be achieved on a population level. The findings provide a benchmark to measure and compare progress toward elimination in the future." Findings from the first year of the initiative were published in the December issue of the journal Clinical Infectious Diseases.

Tibetan refugees in India have high rates of TB, and many children live in congregate settings such as boarding schools, say the researchers. For the study, program staff members first met with parents, educators and home mothers at boarding schools to gain their support.

Then, they screened children in Tibetan schools class by class. Using the schools' administrative records, the researchers ensured that every student and staff member was tested they were screened for TB symptoms such as a cough, fever and night sweats, and were interviewed about TB exposure history. Those presenting with TB symptoms were further evaluated using chest X-ray and laboratory testing.

People with no prior history of TB also underwent tuberculin skin testing, a field-friendly screening tool that allows clinicians to diagnose TB infection by measuring immune response. Between April 2017 and March 2018, the Zero TB in Tibetan Kids project conducted school-based screening for TB disease and infection among a total of 5,391 children and 786 staff members in seven boarding schools and four-day schools in the state of Himachal Pradesh.

Children ranged in age from 5 to 19. Active TB disease was found in 46 children and one staff member, for prevalence in children of 853 per 100,000. An active TB case-finding campaign by the Johns Hopkins Center for Tuberculosis Research and the Delek Hospital in Tibet from 2011 to 2013 identified a prevalence of 394 cases per 100,000 among Tibetan schoolchildren in India, much lower than the current findings.

For the present study, the researchers say that nearly one in five children in this population has TB infection. Worldwide, an estimated one in 28 children has TB infection according to a 2014 Lancet Global Health study.