title: Underuse of effective measures to prevent and manage pediatric tuberculosis in the United States.
abstract: OBJECTIVE
  To characterize problems with prevention and management of pediatric tuberculosis (TB) and latent TB infection (LTBI).
  
  
  METHODS
  A multisite, cross-sectional study using data from medical records and public health logs to categorize and define use of routine prevention practices in managing pediatric TB and LTBI.
  
  
  METHODS
  Four areas of the United States.
  
  
  METHODS
  Children younger than 5 years diagnosed with TB from January 1, 2002, through December 31, 2004, and children with LTBI reported during a continuous 12-month period in 2003 to 2004. Main Exposure Mycobacterium tuberculosis.
  
  
  METHODS
  Underuse or nonuse of standard medical and public health interventions.
  
  
  RESULTS
  Almost 40% of children had a TB risk factor related to their country of birth, parental origin, or travel to a country with a high incidence of TB. Children having LTBI were less likely than those having TB to complete treatment (53.7% vs 88.6%, respectively). Almost half (46.3%) of the children with TB came to medical attention late in their course when they already had symptoms. Among 63 adult source patients, 19 (30.2%) previously had LTBI but were not treated, and none of the 40 foreign-born source patients were known to have been evaluated for TB before entry into the United States.
  
  
  CONCLUSIONS
  Prevention efforts are unsatisfactory to prevent TB in children. Effective interventions such as treatment of LTBI and TB evaluation of adult immigrants remain less than optimal.
authors.affiliation: Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. mark.lobato@ct.gov
authors.forename: Mark N
authors.initials: MN
authors.lastname: Lobato
authors.forename: Sumi J
authors.initials: SJ
authors.lastname: Sun
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Moonan
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Weis
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
authors.forename: Audrey A
authors.initials: AA
authors.lastname: Reichard
authors.forename: Kristina
authors.initials: K
authors.lastname: Feja
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D019090:Case Management; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000706:statistics & numerical data*; D004641:Emigration and Immigration; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D014481:United States / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents