title: Contact investigation and genotyping to identify tuberculosis transmission to children.
abstract: BACKGROUND
  Tuberculosis (TB) in young children is an indicator of ongoing community transmission. We examined contact investigations related to pediatric TB, yield for source case identifications and genotypes for relevant Mycobacterium tuberculosis isolates in a low-incidence setting.
  
  
  METHODS
  We reviewed public health data for all patients with TB aged <18 years reported to Montreal authorities during 1996 to 2000. M. tuberculosis isolates from patients of all ages were subjected to IS6110-based genotyping, supplemented by spoligotyping, to compare isolates from children and adults during the same years.
  
  
  RESULTS
  Sixty-six patients aged <18 years were diagnosed with active TB from 1996 to 2000. Mean age was 11.1 years (standard deviation 6.7 years). Twenty-five children (38%) were Canadian-born, all with at least one foreign-born parent. Nineteen children were diagnosed after contact investigations of known adult cases; 8 underwent no contact investigation. For the remaining 39 children, a total of 616 contacts were identified. The median number of contacts per child was 9 (interquartile range, 6-10). Four hundred eighty-one contacts (78%) underwent tuberculin testing; 188 (39%) were reactors and 186 (39%) began treatment of latent TB. Investigations uncovered 4 probable source cases, all involving parents or other relatives. M. tuberculosis genotyping for 38 children identified up to 14 additional possible source cases; in only one was a possible epidemiologic link evident from public health records.
  
  
  CONCLUSIONS
  Among largely foreign-born children with active TB, contact investigations were extensive and often identified latent tuberculosis infection--but rarely source cases. However, genotyping suggested substantial, previously unrecognized transmission to children despite low overall incidence.
authors.affiliation: Respiratory Epidemiology Unit, McGill University, Montreal, Quebec, Canada.
authors.forename: Ivan K T
authors.initials: IK
authors.lastname: Yeo
authors.forename: Terry
authors.initials: T
authors.lastname: Tannenbaum
authors.forename: Allison N
authors.initials: AN
authors.lastname: Scott
authors.forename: Robert
authors.initials: R
authors.lastname: Kozak
authors.forename: Marcel A
authors.initials: MA
authors.lastname: Behr
authors.forename: Louise
authors.initials: L
authors.lastname: Thibert
authors.forename: Kevin
authors.initials: K
authors.lastname: Schwartzman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015373:Bacterial Typing Techniques; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D004251:DNA Transposable Elements; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D009841:Oligonucleotides / Q000032:analysis; D012150:Polymorphism, Restriction Fragment Length; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*
chemical_list: D004251:DNA Transposable Elements; D009841:Oligonucleotides