![[ Visit Client Website ]](images/banner.jpg)
BACKGROUND: Young children with tuberculosis infection (TBI) are indicative of recent TB transmission. Young children are also at increased risk for rapid progression to TB disease. Consequently, the New York City (NYC) Health Code mandates the reporting of any child <5 years who has TB, is suspected of disease, is a contact to an infectious TB case or has a positive TBI test to the NYC Bureau of TB Control (BTBC). We reviewed these surveillance reports to assess whether more active follow-up is needed to prevent and control TB among this vulnerable population.
METHODS: All children <5 years who were reported to BTBC between 2006-2012 were abstracted from the TB Registry to identify those with TBI. Potential source cases were identified for children; these were defined as any infectious TB case diagnosed in the two years before a child was reported and whose residence was <0.5 miles of the child. Neighborhood risk factors for TB transmission were examined among children with a source case identified.
RESULTS: Among 3511 children reported to BTBC from 2006-2012, 1795 (51%) had TBI. The number of children with TBI reported decreased from 396 in 2006 to 133 in 2012. Children with TBI were 2.4 years of age on average, and most were female (53%) and US-born (64%). The majority of children initiated TBI treatment (86%), and among these, 743 (48%) completed treatment. A potential source case was identified for 1461 (91%) of the 1604 children who had a valid address and were not a contact to a TB case; 26 children lived in the same building as a TB case (2%), 1256 children matched to a case diagnosed <6 months before their report (86%), and 484 had >10 cases within 0.5 miles (33%). Children with a potential source case tended to live in neighborhoods with high TB incidence (61%) and ≥25,000 persons per square mile (79%).
CONCLUSIONS: The high proportion of children with TBI born in the US and the young average age imply that undetected TB transmission may be occurring in NYC. This notion is also supported by the 26 children who lived in the same building as a TB case. Transmission may be associated with residence in areas with exposure risk factors such as high TB incidence and population density. Therefore, monitoring reports of TBI in young children could be used as a method for BTBC to identify transmission and prevent future disease.