[TUBERCULOSIS ANNUAL REPORT 2014--(2) Tuberculosis in Pediatric and Elderly Patients]

In 2014, 49 pediatric tuberculosis (TB) patients aged 0-14 years were newly notified in Japan, with a notification rate of 0.30 per 100,000 population. Since 2006, the number of pediatric TB patients notified each year has been less than 100. Of the 49 patients, 17 (34.7%) were aged 0-4 years, 15 (30.6%) were 5-9 years, and 17 (34.7%) were 10-14 years. Until recently, the proportion of those aged 0-4 years was higher than those aged 10-14 years, but this year the proportions have become equal. Of these 49, five had meningeal TB and two had miliary TB. In terms of case detection, 19 (38.8%) sought health care, while 25 (51.0%) were identified through contact investigations. Since 2000, the number of all elderly patients (aged 65 years or older) with TB decreased rapidly, and remained stable until recently. However, the number of such patients has declined gradually since 2012. The proportion of TB patients aged 65 years or older has consistently increased to as high as 65.4% in 2014; notably, the proportion of TB patients aged 80 years or older has also increased to 37.7%. Since 1999, the TB notification rates in Japan have been consistently higher among patients aged 85 years or older than among those aged 65-84 years. The rate of notification for TB patients aged 65 years or older decreased by 3.1% from 2013 (13,227 patients) to 2014 (12,823 patients). The proportion of bacteriologically positive TB patients among the general population of pulmonary TB (PTB) patients was higher among those aged 65 years or older than among those aged 15-64 years. Among all symptomatic patients, the proportion of PTB patients with only non-respiratory symptoms increased with age to 28.5% among those aged 85 years or older. The proportion of TB patients with a patient delay of two months or longer was lower among patients aged 65 years or older than among those aged 15-64 years (14.5% vs. 28.2%), whereas the proportion of TB patients with a doctor delay of one month or longer was slightly higher among patients aged 65 years or older than among those aged 15-64 years (22.6% vs. 19.5%). Among TB patients aged 65 years or older who were newly notified in 2013, 31.4% died within one year after the initiation of TB treatment; of these patients, 18.8% died within three months. The proportion of deaths within three months after the initiation of TB treatment increased substantially with age, from 8.8% of those aged 65-69 years to 35.6% of those aged 90 years or older.