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Underuse of Effective Measures to Prevent and Manage Pediatric Tuberculosis in the United States
Mark N. Lobato, MD;
Sumi J. Sun, MPH;
Patrick K. Moonan, DrPH;
Stephen E. Weis, DO;
Lisa Saiman, MD, MPH;
Audrey A. Reichard, MPH;
Kristina Feja, MD, MPH; for the Zero Tolerance for Pediatric TB Study Group
Arch Pediatr Adolesc Med. 2008;162(5):426-431.
Objective To characterize problems with prevention and management of pediatric tuberculosis (TB) and latent TB infection (LTBI).
Design A multisite, cross-sectional study using data from medical records and public health logs to categorize and define use of routine prevention practices in managing pediatric TB and LTBI.
Setting Four areas of the United States.
Participants Children younger than 5 years diagnosed with TB from January 1, 2002, through December 31, 2004, and children with LTBI reported during a continuous 12-month period in 2003 to 2004.
Main Exposure Mycobacterium tuberculosis.
Main Outcome Measures Underuse or nonuse of standard medical and public health interventions.
Results Almost 40% of children had a TB risk factor related to their country of birth, parental origin, or travel to a country with a high incidence of TB. Children having LTBI were less likely than those having TB to complete treatment (53.7% vs 88.6%, respectively). Almost half (46.3%) of the children with TB came to medical attention late in their course when they already had symptoms. Among 63 adult source patients, 19 (30.2%) previously had LTBI but were not treated, and none of the 40 foreign-born source patients were known to have been evaluated for TB before entry into the United States.
Conclusions Prevention efforts are unsatisfactory to prevent TB in children. Effective interventions such as treatment of LTBI and TB evaluation of adult immigrants remain less than optimal.
Author Affiliations: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Lobato and Ms Reichard); Tuberculosis Control Branch, California Department of Health Services, Richmond (Ms Sun); Division of Public Health, Department of Medicine, University of North Texas Health Science Center at Fort Worth (Drs Moonan and Weis); and Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York (Drs Saiman and Feja). Dr Moonan is now with the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta. Ms Reichard is now with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia.
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