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PEDIATRICS Vol. 114 No. 2 August 2004, pp. 333-341

Epidemiology of Childhood Tuberculosis in the United States, 1993–2001: The Need for Continued Vigilance

Lisa J. Nelson, MD, MPH, Eileen Schneider, MD, MPH, Charles D. Wells, MD and Marisa Moore, MD, MPH

From the Division of Tuberculosis Elimination, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

Objective. To describe trends and highlight epidemiologic and clinical characteristics of childhood tuberculosis (TB) in the United States.

Methods. All verified TB cases reported to the national TB surveillance system from 1993 to 2001 were included. A child was defined as a person younger than 15 years.

Results. A total of 11 480 childhood TB cases were reported. Case rates (TB cases/100 000 population) in all children declined from 2.9 (n = 1663) in 1993 to 1.5 (n = 931) in 2001. Among children, those who were younger than 5 years had the highest rate. California, Texas, and New York accounted for 48% of all childhood TB cases. In 2001, TB case rates were higher for foreign-born (12.2) than US-born children (1.1). Hispanic and non-Hispanic black children accounted for nearly three quarters of all cases. Twenty-four percent of children with TB were foreign-born children, with the largest number originating from Mexico (39.8%), the Philippines (8.6%), and Vietnam (5.7%). Most children had evidence of pulmonary TB disease (78.9%). Among culture-positive cases without previous TB, drug resistance to at least isoniazid was 7.3% and to isoniazid and rifampin was 1.6%. In 1999, 82.9% of children received directly observed therapy for at least part of their treatment and 94.8% completed treatment.

Conclusions. Although the overall TB case number among children is declining in the United States, certain groups of children (eg, younger children, racial and ethnic minorities, foreign-born) are at higher risk for TB. As the United States moves toward the elimination of TB, future efforts should endeavor to prevent all cases of childhood TB.

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Key Words: epidemiology • tuberculosis • children • pediatrics

Abbreviations: TB, tuberculosis • LTBI, latent tuberculosis infection • HIV, human immunodeficiency virus • RR, relative risk • CI, confidence interval • CDC, Centers for Disease Control and Prevention • TST, tuberculin skin test • INH, isoniazid • MDR, multidrug-resistant • DOT, directly observed therapy

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Received for publication Sep 8, 2003; Accepted Dec 12, 2003.

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