What can we learn from the past?-A pediatrician's view

Area of Science:

• Epidemiology
• Pediatrics
• Infectious Diseases

Background:

• Tuberculosis was historically viewed as a childhood disease during peak epidemics in Europe.
• Significant declines in tuberculosis incidence occurred in Western nations post-1920, predating widespread vaccination and drug treatments.
• By 1970, Sweden reported a tuberculosis incidence rate of 1/100,000, a substantial decrease from earlier periods.

Purpose of the Study:

• To analyze trends in childhood tuberculosis incidence in the Stockholm area between 1971 and 2015.
• To identify factors contributing to changes in childhood tuberculosis rates over the study period.

Main Methods:

• Retrospective analysis of childhood tuberculosis cases in Stockholm.
• Comparison of incidence rates based on country of birth for children and their parents.

Main Results:

• Childhood tuberculosis incidence in Stockholm increased from 1/100,000 to 8/100,000 between 1971 and 2015.
• Increased immigration from high-incidence countries is a primary driver of this rise.
• Foreign-born children, such as Somali children (450/100,000), exhibit significantly higher rates compared to Swedish-born children.
• Sentinel cases, indicative of local transmission, have become rare, suggesting improved public health interventions.

Conclusions:

• Recent increases in childhood tuberculosis in Stockholm are strongly linked to immigration.
• Effective public health measures like contact tracing and early diagnosis have reduced local transmission (sentinel cases).
• Targeted screening and interventions for immigrant populations may be necessary to further control childhood tuberculosis.