TUBERCULOSIS: Pediatric and adolescent tuberculosis in the United States, 2008-2010.

Pediatrics. 2012 Dec;130(6):e1425-32. doi: 10.1542/peds.2012-1057. Epub 2012 Nov 26.

Winston CA, Menzies HJ.

Source

Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-91, Atlanta, GA 30333. cwinston@cdc.gov.

Abstract

OBJECTIVE:

We examined heterogeneity among children and adolescents diagnosed with tuberculosis (TB) in the United States, and we investigated potential international TB exposure risk.

METHODS:

We analyzed demographic and clinical characteristics by origin of birth for persons <18 2008="2008" 2010.="2010." age="age" and="and" available="available" case="case" countries="countries" data="data" describe="describe" disease="disease" for="for" from="from" guardian="guardian" having="having" history="history" incident="incident" internationally="internationally" lived="lived" national="national" newly="newly" of="of" on="on" or="or" origin="origin" p="p" parent="parent" patients="patients" pediatric="pediatric" reported="reported" surveillance="surveillance" system="system" tb="tb" to="to" verified="verified" we="we" with="with" years="years">

RESULTS:

Of 2660 children and adolescents diagnosed with TB during 2008-2010, 822 (31%) were foreign-born; Mexico was the most frequently reported country of foreign birth. Over half (52%) of foreign-born patients diagnosed with TB were adolescents aged 13 to 17 years who had lived in the United States on average >3 years before TB diagnosis. Foreign-born pediatric patients with foreign-born parents were older (mean, 7.8 years) than foreign-born patients with US-born parents (4.2 years) or US-born patients (3.6 years). Among US-born pediatric patients, 66% had at least 1 foreign-born parent, which is >3 times the proportion in the general population. Only 25% of pediatric patients with TB diagnosed in the United States had no known international connection through family or residence history.

CONCLUSIONS:

Three-quarters of pediatric patients with TB in the United States have potential TB exposures through foreign-born parents or residence outside the United States. Missed opportunities to prevent TB disease may occur if clinicians fail to assess all potential TB exposures during routine clinic visits.