title: Paediatric tuberculosis cases increased in Stockholm from 1971 to 2015 following the rising number of children with immigrant backgrounds.
abstract: OBJECTIVE
  This study described the epidemiology and clinical features of childhood tuberculosis (TB) in Stockholm over a 45-year period, when there was a resurge of tuberculosis concomitant with increased immigration.
  
  
  METHODS
  We describe 220 children up to the age of 16 years with active TB, seen at the Astrid Lindgren Children's Hospital from 1971 to 2015. The study period was divided into three 15-year periods.
  
  
  RESULTS
  Cases increased from ten children in 1971-1985 to 76 in 1986-2000 and 134 in 2001-2015, with overall incidence increasing from <1 to four per 100 000. From 2001 to 2015, 79% of cases, or at least one parent, were born in high-incidence countries. The incidence in this group was 35 per 100 000, but remained at 0.9 per 100 000 in other children. After 2000, most cases were detected by active contact tracing and immigrant screening. The most common manifestation was from the lungs. Meningitis and miliary tuberculosis were found in 7%, with two deaths. Antimicrobial resistance was an increasing problem.
  
  
  CONCLUSIONS
  The increasing incidence of TB in Stockholm was largely limited to children with a background in high-incidence countries. Most children today have subclinical forms of TB. Although preventive measures are effective, severe cases still occur, especially among adolescent immigrants.
authors.affiliation: Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Rutger
authors.initials: R
authors.lastname: Bennet
authors.affiliation: Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Eriksson
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002947:Cities / Q000453:epidemiology; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D013548:Sweden / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology*
keywords: Epidemiology; Immigrants; Prevention; Screening; Tuberculosis