The Global Nature of Childhood Tuberculosis

Abstract

* Abbreviations: CDC — : Centers for Disease Control and Prevention LTBI — : latent tuberculosis infection TB — : tuberculosis WHO — : World Health Organization After several decades of neglect, childhood tuberculosis (TB) is receiving some of the attention it deserves. Although the common perception is that TB has disappeared from the United States, there are almost 10 000 cases annually, with >1000 occurring in children.1 There are many thousands of children with untreated latent TB infection (LTBI) at risk of developing TB disease, who either were missed during contact investigation of adults with TB disease in the United States or who were not tested during immigration to the United States. Pang et al2 describe the epidemiology of TB in preschool-aged US children. They highlight and quantify a recently described risk factor for childhood TB in a low-incidence setting: parental foreign birth. A 2012 Pediatrics article found that two-thirds of all children and adolescents with TB in the United States had at least 1 foreign-born parent, and only one-quarter of children with TB lacked an international connection.3 Before 2009, children immigrating to the United States were not routinely tested for LTBI or TB disease. The 2009 Centers for Disease Control and Prevention (CDC) Technical Instructions for children immigrating to the United States endorse testing children ages 2 to 14 years for LTBI and treatment of infected children after arrival in the United States.4 The hope is that this immigration screening protocol will decrease the reservoir for future cases among the foreign-born. However, some US-born children with LTBI are not detected by existing screening algorithms. Having a foreign-born parent is not currently included as a risk factor in the American Academy of Pediatrics–endorsed LTBI screening questionnaire … Address correspondence to Jeffrey R. Starke, MD, 1102 Bates St, Suite 1150, Houston, TX 77030. E-mail: jstarke{at}bcm.edu