Epidemiologic characteristics of pediatric active tuberculosis among immigrants from high to low tuberculosis-endemic countries: the Israeli experience.
BACKGROUND
During the last decade, Israel, a country with low tuberculosis rates, absorbed some 900,000 new immigrants from TB-endemic countries.


OBJECTIVE
To analyze the specific impact of our screening procedures on active TB among children in Israel.


METHODS
We conducted a retrospective analysis of epidemiologic and clinical data of all children (aged 0-17) with TB notified to the Ministry of Health between 1990 and 1999.


RESULTS
There were 479 children with TB (male/female ratio 1.36). Most cases (81.8%) were foreign born, predominantly (88.2%) immigrants from Ethiopia and, therefore, huge differences existed in TB incidence rates according to countries of origin. Some 80% were diagnosed within 3 years of arrival, mainly due to active case-finding. Pulmonary TB, with infiltrates on chest X-ray, was found in 49.5%. Extra-pulmonary TB sites were: intra-thoracic lymphadenitis (31.1%), extra-thoracic lymphadenitis (12.5%), bones (3.6%), pleura (1.3%), meninges (1%), and others (1%). Seventy percent had a tuberculin skin test reaction > or =10 mm in size. Two (non-immigrant) children died of TB meningitis.


CONCLUSIONS
Most of the pediatric TB cases occurred in recent immigrants and were diagnosed within 3 years of immigration. These data support our policy of active case-finding among new immigrants from Ethiopia and extensive contact evaluation for all TB cases.
Chemtob
Daniel
D
Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel. daniel.chemtob@moh.health.gov.il
Weiler-Ravell
Daniel
D
Leventhal
Alex
A
Bibi
Haim
H
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D004641:Emigration and Immigration; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D010043:Outcome and Process Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D014376:Tuberculosis / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology*