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Completeness of pediatric TB reporting in New York City
Pablo San Gabriel1, Lisa Saiman, Katherine Kaye
1Department of Pediatrics, Columbia University, New York, NY 10032, USA. pas58@columbia.edu
Insights
This study developed an alternative surveillance method for pediatric tuberculosis (TB) in New York City. The new approach successfully identified previously unreported TB cases, improving case detection by 21%.
Area of Science:
- Public Health
- Pediatric Infectious Diseases
- Epidemiology
Background:
- Accurate surveillance of pediatric tuberculosis (TB) is crucial for identifying recent transmission events.
- Traditional TB surveillance methods often struggle with low culture confirmation rates (10-50%), making case identification challenging.
- Existing surveillance systems may miss a significant number of pediatric TB cases.
Purpose of the Study:
- To develop and assess an alternative surveillance system for pediatric TB.
- To evaluate the completeness of existing reporting for pediatric TB cases in northern Manhattan and Harlem.
- To compare alternative surveillance findings with data from the New York City Department of Health (NYC DOH).
Main Methods:
- Utilized hospital-based data, including ICD-9-CM codes for active TB and gastric aspirate reports, for alternative surveillance.
- Compared cases identified through the alternative surveillance system with those previously reported to the NYC DOH.
- Analyzed demographic and clinical characteristics of both detected and undetected pediatric TB cases.
Main Results:
- The alternative surveillance identified 25 possible pediatric TB cases.
- Four cases (16%) were never reported to the NYC DOH, and three (12%) were reported as suspect but not confirmed.
- The alternative surveillance increased the identification of pediatric TB cases by 21% compared to existing methods.
Conclusions:
- Alternative surveillance methods are effective and complementary to existing public health surveillance.
- The developed approach significantly enhances the detection of pediatric TB cases.
- Improved surveillance is vital for accurate understanding and control of pediatric TB transmission.
Objective:
Accurate surveillance of tuberculosis (TB) in children is critical because such cases represent recent transmission, but surveillance is difficult as only 10% to 50% of cases are culture-confirmed. Hospital-based sources were used to develop alternative surveillance to assess completeness of reporting for pediatric TB in northern Manhattan and Harlem from 1993 through 1995.
Methods:
Alternative surveillance sources included ICD-9-CM hospital discharge codes for active TB and gastric aspirate reports. Cases identified by alternative surveillance were compared with cases previously reported to the New York City Department of Health (NYC DOH).
Results:
Alternative surveillance detected 25 cases of possible pediatric TB, of which four (16%) had never been reported to the NYC DOH and three (12%) had been reported as suspect cases, but had not fulfilled the criteria for a reportable case of pediatric TB. Of these seven newly counted cases, three were detected by ICD-9-CM codes, three by a gastric aspirate log book, and one by both. In contrast, 13 other cases had been reported to the NYC DOH, but were undetected by our alternative surveillance; eight of these could be verified with available medical records. Thus, the demographic and clinical characteristics of the 25 detected and the eight undetected cases with available medical records were evaluated in this study.
Conclusion:
Alternative surveillance proved effective, was complementary to the NYC DOH surveillance efforts, and increased the number of pediatric TB cases identified during the study period by 21%.