title: Epidemiology of tuberculosis in children in London, 2009-2011: are opportunities for prevention being missed?
abstract: METHODS
  London, United Kingdom.
  
  
  OBJECTIVE
  To explore missed opportunities (MO) for the prevention of tuberculosis (TB) in children aged 0-15 years.
  
  
  METHODS
  Parents/guardians of children aged <15 years diagnosed with TB and reported through surveillance were interviewed about bacille Calmette-Guérin vaccination (MO-V) or contact tracing and screening for TB (MO-C) via an algorithm reflecting eligibility.
  
  
  RESULTS
  Annual TB incidence was 12 per 100,000 (65/100,000 in Black Africans, 20/100,000 in Indian or Pakistani children). The response rate was 36% (145/405). About 20% of UK-born children had not been vaccinated. MO-V was not associated with any particular factor. Contact with a known TB case before illness had occurred in 71 children (49%; 71% in those aged 0-1 years vs. 30% in those aged 11-15 years), of whom 64 (91%) were diagnosed through contact tracing. MO-C had been conducted in six (4% overall). Children with MO-C were all of Black ethnic origin. Their index cases were family members (within their household) or relatives or family friends from abroad (outside their household). MO-C was not associated with any other factor.
  
  
  CONCLUSIONS
  Although overall few missed opportunities for prevention had occurred, we recommend increased rigour when performing contact tracing in any case where a child may have been exposed.
authors.affiliation: Health Protection Agency, London Region Epidemiology Unit, London, UK; European Programme for Intervention Epidemiology Training, European Centre for Disease Control and Prevention, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Le Polain de Waroux
authors.forename: D
authors.initials: D
authors.lastname: Pedrazzoli
authors.forename: D
authors.initials: D
authors.lastname: Shingadia
authors.forename: N Q
authors.initials: NQ
authors.lastname: Verlander
authors.forename: S
authors.initials: S
authors.lastname: Jama
authors.forename: L
authors.initials: L
authors.lastname: Altass
authors.forename: H
authors.initials: H
authors.lastname: Maguire
mesh_terms: D000293:Adolescent; D000367:Age Factors; D044466:Asian People; D001500:BCG Vaccine / Q000008:administration & dosage; D044383:Black People; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D016358:Contact Tracing; D058872:Epidemics / Q000517:prevention & control; D005191:Family Characteristics; D005260:Female; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007194:India / Q000208:ethnology; D007223:Infant; D007231:Infant, Newborn; D008131:London / Q000453:epidemiology; D008297:Male; D010154:Pakistan / Q000208:ethnology; D012111:Residence Characteristics; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000208:ethnology* / Q000517:prevention & control*; D044465:White People
chemical_list: D001500:BCG Vaccine