title: Increased reported cases of tuberculosis among children younger than 5 years of age, Maricopa County, Arizona, 2002-2003.
abstract: OBJECTIVE
  Although tuberculosis (TB) rates in the United States among children younger than 5 years old (2.8/100,000 in 2003) have been declining, Maricopa County, Arizona, reported an increase from 4.1/100,000 in 2002 to 9.0/100,000 in 2003. We investigated factors associated with this increase.
  
  
  METHODS
  We reviewed county TB clinic records of pediatric patients (younger than 5 years old) and their probable adult sources, interviewed parents or guardians of pediatric TB patients and examined changes in clinic procedures.
  
  
  RESULTS
  We verified 11 pediatric TB cases in 2002 and 25 in 2003 (n = 36). A total of 31 (86%) patients were born in the United States, and 28 (78%) had at least 1 foreign-born parent. There were 19 children (53%) identified from an adult TB contact investigation. Of children with identified sources (n = 24, 67%), 23 (96%) had probable household transmission; 20 (83%) had a foreign-born relative from a TB-endemic country as the probable source. Seven (50%) of 14 adult sources investigated had a delayed TB diagnosis. In 2003, increased TB clinic staffing, more frequent pediatric TB clinics and on-site gastric aspirates for TB diagnosis contributed to 55% more children being evaluated for TB.
  
  
  CONCLUSIONS
  Close interaction with family members and delayed diagnoses were the primary means of TB transmission to children. The increase in pediatric TB likely reflects improved clinic diagnostic capacity and may indicate a more accurate baseline rate for Maricopa County. Programmatic improvements in TB control and targeted outreach to high-risk immigrant populations may increase pediatric and adult source case detection and reduce Mycobacterium tuberculosis transmission.
authors.affiliation: Epidemic Intelligence Service, Office of Workforce and Career Development, Atlanta, GA, USA.
authors.forename: N Sarita
authors.initials: NS
authors.lastname: Shah
authors.forename: Theresa
authors.initials: T
authors.lastname: Harrington
authors.forename: Marty
authors.initials: M
authors.lastname: Huber
authors.forename: Chasity
authors.initials: C
authors.lastname: Wellnitz
authors.forename: Sara
authors.initials: S
authors.lastname: Fridrych
authors.forename: Kayla
authors.initials: K
authors.lastname: Laserson
authors.forename: Idalia M
authors.initials: IM
authors.lastname: Gonzalez
authors.forename: Kashef
authors.initials: K
authors.lastname: Ijaz
mesh_terms: D001130:Arizona / Q000453:epidemiology; D002675:Child, Preschool; D018563:Disease Notification / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission