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Epidemiology of tuberculosis in young children in the United States
Jenny Pang1, Larry D Teeter, Dolly J Katz
1Department of Epidemiology, University of Washington, Seattle, Washington;
Insights
Tuberculosis (TB) rates are significantly higher in US-born children with foreign-born parents compared to those with US-born parents. This highlights the need for targeted TB interventions in this vulnerable population.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Tuberculosis (TB) remains a public health concern, particularly among vulnerable populations.
- Understanding TB epidemiology in young children is crucial for effective control strategies.
- Birth origin of children and parents is a key factor influencing TB risk.
Purpose of the Study:
- To estimate tuberculosis (TB) rates in young children (<5 years) in the US based on birth origins.
- To describe the epidemiology of TB in foreign-born children and US-born children with foreign-born parents.
- To identify risk factors and transmission patterns within these groups.
Main Methods:
- Observational study analyzing TB cases in 20 US jurisdictions (2005-2006).
- TB rates calculated using TB case counts and American Community Survey population estimates.
- Data collected via parental interviews, health department records, and TB surveillance, including demographics, immigration/travel history, and source case details.
Main Results:
- TB rates were 32x higher in foreign-born children and 6x higher in US-born children with foreign-born parents compared to US-born children with US-born parents.
- Children born in the US to foreign-born parents constituted 53% of cases, despite being only 29% of the population studied.
- US-born children of foreign-born parents were more likely to be infants, Hispanic, diagnosed via contact tracing, and have an identified source case, with two-thirds exposed in the US.
Conclusions:
- US-born children of foreign-born parents experience disproportionately high TB rates and represent the majority of cases in this age group.
- Prompt diagnosis and treatment of adult TB cases are essential.
- Targeted contact investigations prioritizing young children and latent TB infection treatment are necessary to reduce TB morbidity.
Objectives:
To estimate tuberculosis (TB) rates among young children in the United States by children's and parents' birth origins and describe the epidemiology of TB among young children who are foreign-born or have at least 1 foreign-born parent.
Methods:
Study subjects were children <5 years old diagnosed with TB in 20 US jurisdictions during 2005-2006. TB rates were calculated from jurisdictions' TB case counts and American Community Survey population estimates. An observational study collected demographics, immigration and travel histories, and clinical and source case details from parental interviews and health department and TB surveillance records.
Results:
Compared with TB rates among US-born children with US-born parents, rates were 32 times higher in foreign-born children and 6 times higher in US-born children with foreign-born parents. Most TB cases (53%) were among the 29% of children who were US born with foreign-born parents. In the observational study, US-born children with foreign-born parents were more likely than foreign-born children to be infants (30% vs. 7%), Hispanic (73% vs. 37%), diagnosed through contact tracing (40% vs. 7%), and have an identified source case (61% vs. 19%); two-thirds of children were exposed in the United States.
Conclusions:
Young children who are US born of foreign-born parents have relatively high rates of TB and account for most cases in this age group. Prompt diagnosis and treatment of adult source cases, effective contact investigations prioritizing young contacts, and targeted testing and treatment of latent TB infection are necessary to reduce TB morbidity in this population.
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