Study finds nearly 1 in 5 exile Tibetan Schoolchildren with Tuberculosis Infection

Tibetan Children's Village in North India, Himachal Pradesh. (Photo courtesy: TCV)
Tibetan Children’s Village in North India, Himachal Pradesh. (Photo courtesy: TCV)

(, Dec19, 2018) – The rate of tuberculosis infection among Tibetan schoolchildren in India is nearly one in five against the worldwide estimated of one in 28 children, said a report Dec 18, citing a study conducted by a team directed by researchers at Johns Hopkins Medicine and the University of Wisconsin. The finding was stated to be based on a screening and treatment initiative covering the entire population of Tibetan refugee schoolchildren in northern India. The Tibetan rate along children in boarding schools was stated to be five to eight times higher than the global or other country rates.

The team has said it had 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,” lead study author Kunchok Dorjee, PhD, MBBS, was quoted as saying. Dr Dorjee is a research associate at the Johns Hopkins University School of Medicine. He is also the 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.

“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,” Dr Dorjee was further quoted as saying.

The study’s latest finding, covering the period of Apr 2017-Mar 2018, was stated to have found the prevalence of TB infection among Tibetan schoolchildren in northern India to be much higher than that from a previous study which covered the period of 2011-2013.

An active TB case-finding campaign by the Johns Hopkins Center for Tuberculosis Research and the Delek Hospital at Dharamsala, India, carried out from 2011 to 2013, had identified a prevalence of 394 cases per 100,000 among Tibetan schoolchildren in India.

The current study, conducted between Apr 2017 and Mar2018 under 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 a prevalence rate in children of 853 per 100,000, which is much higher than the prevalence found in the 2011-13 study.

For the current study, the researchers have said, nearly one in five children in this population had TB infection.

Besides, TB infection without disease was reported to have been detected in 930 of 5,234 schoolchildren (18 percent) and 334 of 634 staff members (53 percent).

TB rates among children in the boarding schools in Dharamsala (which is in Himachal Pradesh) was reported to be about five to eight times higher than the average for India, China, or globally.

Among the variety of reasons for this, Dr Dorjee has said about 26 percent of students had reported exposure to someone with active TB in the previous two years at school.

High success rate was reported for a treatment programme carried out by the team.  Its report was cited as saying that while treatment adherence tends to be a challenge in many populations impacted by TB, most participants in the latest study (nearly 95 percent, or 857) successfully completed their drug regimen for TB prevention. Less than 2 percent of the participants (12 people) were unable to complete the full recommended therapy, mostly due to side effects, it was states. Therapy was reported to be ongoing for 3 percent of the participants at the time of the study’s publication.

Co-authors of the study were stated to include Andrea DeLuca and Elizabeth Bonomo of Johns Hopkins, and researchers, nurses, physicians and public health experts from the Division of Tuberculosis at Delek Hospital, the Tibetan Children’s Village school and the Central Tibetan Administration’s Department of Health, and the Department of Family Medicine and Community Health at the University of Wisconsin.

The study was stated to have been supported by grants from the Tibet Fund, the Friends of Tibetan Delek Hospital, the Pittsfield Anti-Tuberculosis Association, the Johns Hopkins Alliance for a Healthier World and private donations.


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