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Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1141-1147 (doi:10.1542/peds.2004-2701)
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Epidemiology of Pediatric Tuberculosis Using Traditional and Molecular Techniques: Houston, Texas

Susan H. Wootton, MD*, Blanca E. Gonzalez, MD*, Rebecca Pawlak, MS{ddagger}, Larry D. Teeter, PhD{ddagger}, Kim Connelly Smith, MD, MPH§, James M. Musser, MD, PhD{ddagger},||, Jeffrey R. Starke, MD*, Edward A. Graviss, PhD, MPH{ddagger},¶

* Department of Pediatrics, Infectious Disease Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
{ddagger} Pathology
Medicine, Baylor College of Medicine, Houston, Texas
§ Department of Pediatrics, University of Texas-Houston Medical School, Houston, Texas
|| Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana

Objective. To investigate the transmission dynamics of pediatric tuberculosis (TB) by analyzing the clinical characteristics with the molecular profiles of Mycobacterium tuberculosis isolates during a 5-year period.

Methods. A retrospective review of a prospective population-based active surveillance and molecular epidemiology project was conducted in private and public pediatric clinics within Houston and Harris County, Texas. The study population consisted of patients who had pediatric TB diagnosed from October 1, 1995, through September 30, 2000. Cases and potential source cases (PSC) were interviewed using a standardized questionnaire. Available Mycobacterium tuberculosis isolates from cases and PSCs were characterized and compared by IS6110 restriction fragment length polymorphism, spoligotyping, and genetic group assignment. Clinical characteristics were described, and molecular characterizations were compared. Data were analyzed by using EpiInfo 6.02b and SAS 8.2.

Results. A total of 220 (92%) of 238 pediatric TB cases were included. Epidemiologic and clinical findings were consistent with previous studies. Molecular profiles from 3 cases did not match the profile of PSC. Four previously unknown PSCs were identified using molecular techniques. Fifty-one (71.8%) of 71 isolates matched at least 1 other Houston Tuberculosis Initiative TB database isolate and were grouped into 33 molecular clusters. Cases were more likely to be clustered when the patients were younger than 5 years, identified a source case, or were US born.

Conclusions. Traditional contact tracing may not always be accurate, and molecular characterization can lead to identification of previously unrecognized source cases. Recent transmission plays a significant role in the transmission of TB to children as evident by the high degree of clustering found in our study population.

Key Words: epidemiology • infectious disease • pediatric • tuberculosis

Abbreviations: TB, tuberculosis • MTB, Mycobacterium tuberculosis • TCR, TB Control Registry • HTI, Houston Tuberculosis Initiative • TST, tuberculin skin test • PSC, potential source case • RFLP, restriction fragment length polymorphism • OR, odds ratio • CI, confidence interval • CSF, cerebrospinal fluid

Accepted Feb 4, 2005.


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