A Retrospective Cohort Analysis of Pediatric Tuberculosis in North Carolina, 1994-2002

Background: The incidence of pediatric tuberculosis (TB) in North Carolina decreased from the mid 1990s to 200l. In 2002, the number of pediatric TB cases increased from 9 in 2001 to 32 in 2002, representing more than a 250% increase. Objective: To describe the epidemiology and clinical characteristics of pediatric TB in North Carolina and identify factors contributing to the rise in tuberculosis cases among children less than 15 years of age. Methods: Retrospective review of TB surveillance data and local health department records of all reported pediatric TB cases and their source case between the years 1994 and 2002. Results: 180 cases of pediatric TB were reported from 1994-2002. The incidence of pediatric TB increased from 0.53 to 1.85 per 100,000 from 2001 to 2002. TB case rates in 2002 were higher in children less than 5 years of age (3.05 per 100,000) compared to children 5-14 years of age (1.28 per 100,000). TB case rates were 10- to 44-fold higher among minority children compared to non-Hispanic white children. Although there was no significant increase in the incidence of TB in the Hispanic pediatric population, there was a significant increase in the proportion of Hispanic children with tuberculosis (p-value =.04). Children with a foreign association accounted for an increasing proportion of pediatric TB cases over time, however, the increase was not statistically significant (p-value = 0.09). Transmission of TB to children could have been prevented in 6.75% of cases had a source case identified the child as a contact, and in 11.7% of cases had the source case completed prophylaxis for latent TB infection. TB disease may have been prevented in 7.2% of cases had the contact investigation not been delayed, 2.2% of cases had children with latent TB infection completed prophylaxis, and in 4.4% of cases had child contacts <5 years of age with a negative PPD taken or received prophylaxis. Overall, 51/180 cases (28.3%) might have been prevented had appropriate measures been taken. Conclusion: The incidence of pediatric TB increased significantly from 2001 to 2002. TB in the minority population continues to be a problem. TB in children with a foreign-association is increasing. Improvements in contact investigations and completion of prophylaxis for LTBI may reduce the incidence of pediatric TB.