Paediatric tuberculosis in a Pacific Islands community in New Zealand.
OBJECTIVE
To describe the demographic, clinical and management aspects of an outbreak of tuberculosis (TB) within a paediatric Pacific Island community in Auckland, New Zealand, in 2002-2003.


METHODS
The index and source case are described along with details of the extensive contact tracing that was undertaken in this community.


RESULTS
A total of 24 children were diagnosed with TB over an 11-month period. All cases were found to be epidemiologically linked to the one source case, mother of the index case. This total included 22 children with pulmonary disease, 1 case of miliary disease (index case) and 1 of cervical adenitis. Only 58% had symptoms at diagnosis and only 5 presented to medical attention with symptoms, the remainder had symptoms disclosed after contact tracing occurred. The Mycobacterium tuberculosis isolate was fully sensitive and all children (excluding the child with miliary disease) received short course directly observed therapy. One child developed hepatotoxicity requiring modification of his drug regimen.


CONCLUSIONS
Children are at high risk of developing active disease after exposure to TB. The study describes the minimal symptoms manifested in many of the children with significant radiological changes consistent with pulmonary TB. This highlights the need to consider Mantoux testing and chest X-rays for children presenting with persistent respiratory symptoms in high-risk populations. Issues of contact tracing and adherence were also a problem in this population.
Voss
Lesley
L
Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand.
Campbell
Mary
M
Tildesley
Christine
C
Hay
Deborah
D
Vaughan
Anne
A
Thornley
Craig
C
D000328:Adult; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage; D002584:Cervix Uteri / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D003371:Cough / Q000175:diagnosis; D023801:Directly Observed Therapy; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000150:complications; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D009035:Mothers; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009520:New Zealand / Q000453:epidemiology; D010139:Pacific Islands / Q000208:ethnology; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology
D000904:Antibiotics, Antitubercular