A sustained programme of screening and preventive treatment has led to a sharp decline in tuberculosis (TB) among Tibetan refugee children in northern India, offering fresh evidence that existing public health tools can significantly reduce disease transmission in high-burden settings.
A prospective analysis of the Johns Hopkins Medicine-led ‘Zero TB in Kids’ initiative has found that TB incidence among schoolchildren dropped by 83% over an eight-year period. The findings, published in the latest issue of The Lancet Regional Health – Southeast Asia, highlight the impact of a structured, community-based approach using regular screening and tuberculosis preventive treatment (TPT).
The programme, launched in 2017, was implemented in congregate settings such as schools, monasteries, and nunneries in northern India, where Tibetan refugee children live and study. These environments are often considered high-risk due to close contact and prolonged exposure, making them critical targets for intervention.
According to Kunchok Dorjee, project director of the initiative and faculty at the Johns Hopkins University School of Medicine, the results demonstrate what can be achieved with consistent application of existing TB control measures.
“Over the eight-year period, screening and TPT led to an 83% reduction in TB incidence and a 32% reduction in latent TB infection among children,” Dr. Dorjee said. “After even one round of intervention, new infections declined by 59%.”
The study also found that TB prevalence fell even among children who did not receive preventive treatment, suggesting a broader reduction in community transmission. This contrasts sharply with the global average decline in TB incidence, which remains at around 2% annually.
A latent TB infection occurs when a person acquires the TB pathogen—the bacterium known as Mycobacterium tuberculosis—but does not have symptoms and is not infectious at that time, but could become active and infectious in the future.
Tuberculosis continues to be one of the leading infectious disease challenges globally, particularly in countries such as India, which accounts for nearly a quarter of the world’s TB burden. The findings are therefore significant in demonstrating that large-scale impact is possible without new drugs or technologies.
The programme relied on systematic screening, early diagnosis, and preventive therapy for children at risk of developing active TB. Latent TB infection—where individuals carry the bacteria but show no symptoms—was a key focus. Without treatment, such cases can progress to active disease and contribute to further spread.
Dr. Dorjee noted that despite disruptions caused by the COVID-19 pandemic, the programme maintained its effectiveness over time. “There was a temporary increase in infections during the pandemic, but once screening and treatment resumed, the declining trend returned,” he said.
The study also identified certain gaps. Children with conditions such as hepatitis B and seizure disorders were less likely to receive preventive treatment, possibly due to concerns among physicians about drug interactions or side effects. Researchers have called for clearer clinical guidelines to address such cases and improve treatment coverage.
The initiative was partially funded by the National Institute of Allergy and Infectious Diseases and involved collaboration with multiple institutions, including India’s National TB Elimination Programme and the Central Tibetan Administration.
Experts said the findings carry important policy implications. The study has recommended a shift in global TB control strategies—from focusing primarily on active disease to also targeting latent infections through preventive treatment. It has also called for mass screening in high-risk settings such as schools and residential institutions.
Importantly, the programme also underscores the value of community-led efforts. Local participation, regular follow-ups, and sustained engagement were central to its success. By combining medical intervention with community outreach, the initiative was able to build trust and ensure adherence to treatment, said the study.
