Adolescent Females are More Susceptible than Males for Tuberculosis

Background and Objectives: Published literature is silent about the gender gap in tuberculosis (TB) among adolescent (10-19 years) population despite extensive information on increased susceptibility of the male gender after 20 years. We analyzed the data from 1113 adolescent microbiologically confirmed TB cases using cartridge-based nucleic acid amplification test (CBNAAT) in 2019 in the State of Himachal Pradesh (HP), India. Materials and Methods: The data generated by 39 CBNAAT sites in HP were analyzed with an objective to describe the gender gap in TB among adolescents. Results: Among 983 patients with pulmonary TB (PTB), the male: female ratio was 1:1.5 (P = 0.0001), whereas in 130 patients with extra PTB (EPTB), the male: female ratio was 1:1.8 (P = 0.0001). This male: female ratio was seen to reverse after 20 years for PTB, and but it persisted till 40 years for EPTB. Two main forms of TB that were significantly high in females during adolescence were PTB and lymph node TB (P = 0.0001). Interpretation and Conclusions: Significant gender difference with female susceptibility was seen for TB among adolescents, a fact that needs more research. Adolescent TB is a neglected area with little published data driven mainly by the fact that most countries report their TB population above and below 15 years, dividing the adolescent population into two halves. The world needs to acknowledge adolescents (10-19 years) as a separate important group for reporting TB statistics.