Underuse of effective measures to prevent and manage pediatric tuberculosis in the United States.
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.
Lobato
Mark N
MN
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. mark.lobato@ct.gov
Sun
Sumi J
SJ
Moonan
Patrick K
PK
Weis
Stephen E
SE
Saiman
Lisa
L
Reichard
Audrey A
AA
Feja
Kristina
K
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
D000995:Antitubercular Agents