title: Tuberculosis in New Zealand, 1992-2001: a resurgence.
abstract: OBJECTIVE
  To describe the recent epidemiology and clinical features of paediatric tuberculosis (TB) in New Zealand (NZ).
  
  
  METHODS
  A retrospective review was conducted of clinical, laboratory, and radiology records of children <16 years old diagnosed with TB between January 1992 and June 2001 in nine NZ health districts.
  
  
  RESULTS
  A total of 274 patients <16 years old were identified; the average annual TB rate was 4.8 per 100,000. Rates rose over time reaching a peak of 10.1 in 1999. Rates were highest in under-5 year olds, at 6.2 per 100,000, and varied by ethnicity: African 575.2, Pacific Island 15.2, Maori 6.4, Asian 5.6, and European 0.6. Seventy two cases (26%) were foreign born. Thirty six per cent of cases were not detected until they presented with symptoms and of these 44% had no known TB contact. Most cases were identified by contact tracing (48%) or immigrant screening (11%); 43% were part of outbreaks. Miliary TB or meningitis occurred in 8% of patients, two of whom died. Drug resistance was found in 7% of culture positive cases and no HIV co-infection was found.
  
  
  CONCLUSIONS
  A resurgence of TB occurred among children in NZ between 1992 and 2001 predominantly involving non-European and immigrant groups. Despite established contact tracing and immigrant screening programmes, many cases were part of outbreaks, remained unidentified until symptoms arose, or had no known TB contact. These findings point to an unrecognised burden of adult disease, ongoing community transmission, and missed opportunities for prevention. Further study is required to confirm these hypotheses.
authors.affiliation: Division of Paediatrics, University of Auckland, Auckland, New Zealand. showie@mrc.gm
authors.forename: S
authors.initials: S
authors.lastname: Howie
authors.forename: L
authors.initials: L
authors.lastname: Voss
authors.forename: M
authors.initials: M
authors.lastname: Baker
authors.forename: L
authors.initials: L
authors.lastname: Calder
authors.forename: K
authors.initials: K
authors.lastname: Grimwood
authors.forename: C
authors.initials: C
authors.lastname: Byrnes
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D011203:Poverty / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology