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Epidemiology of Pediatric Tuberculosis in the United States, 1993–2010

Epidemiology of Pediatric Tuberculosis in the United States, 1993–2010. Surveillance, Epidemiology, and Outbreak Investigations Branch Division of Tuberculosis Elimination Centers for Disease Control and Prevention (CDC).

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Epidemiology of Pediatric Tuberculosis in the United States, 1993–2010

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  1. Epidemiology of Pediatric Tuberculosis in the United States, 1993–2010 Surveillance, Epidemiology, and Outbreak Investigations Branch Division of Tuberculosis Elimination Centers for Disease Control and Prevention (CDC) National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Tuberculosis Elimination

  2. Pediatric TB—Background • Definition of pediatric tuberculosis (TB): TB disease in a person < 15 years old • In 2010: • 11,182 TB cases were reported among all age groups • 637 (5.7%) were pediatric • 365 (3.3%) in ages 0 – 4 • 272 (2.4%) in ages 5 – 14

  3. 2009 TB Case Definition and Verification • Incident case of disease • Case verification categories: • Laboratory confirmed cases (Gold Standard): • Positive culture or nucleic acid amplification test • Positive AFB smear when culture not attainable • Clinical case definition • Positive tuberculin skin test or positive interferon gamma release assay • Signs and symptoms of TB disease • Current treatment for TB disease • Completed diagnostic evaluation • Provider diagnosis • Diagnosed by health care provider • Does not fulfill all criteria necessary to meet laboratory or clinical case definitions

  4. TB Cases, All Ages, by Age Group, 1993–2010 TB Cases Year

  5. TB Case Rates, All Ages, by Age Group,1993–2010 TB Case Rate per 100,000 Year Note: Rates presented on a logarithmic scale

  6. Percent of Pediatric TB Cases by Age Group,1993–2010N=18,783

  7. Pediatric TB Cases by Age Group, 1993–2010N=18,783 TB Cases Year

  8. Pediatric TB Case Rates by Age Groups, 1993–2010N=18,783 TB Case Rate per 100,000 Year Note: Rates presented on a logarithmic scale

  9. Pediatric TB Cases by Race/Ethnicity, 1993–2010N=18,783 Pediatric TB Cases Year Note: Unknown and multiple race/ethnicity not shown

  10. Pediatric TB Case Rates by Race/Ethnicity, 1993–2010N=18,783 TB Case Rate per 100,000 Note: Rates presented on a logarithmic scale. American Indian/Alaska Native rate not shown because of small denominators

  11. Pediatric TB Case Rates by Age GroupsU.S.-born and Foreign-born, 1994–2010,N=17,054 Foreign-born TB Case Rate per 100,000 U.S.-born Year Note: Rates presented on a logarithmic scale. Data not available before 1994. USB = U.S.-born, FB=Foreign-born (unknown excluded from table and counts)

  12. Number and Percent of Pediatric TB Cases by U.S. and Foreign Birth, 1993–2010 Percent Number of Pediatric TB Cases

  13. 1999–2002 (n) 2003–2006 (n) 2007–2010 (n) Number of Pediatric TB Cases with Foreign Birth by Birth Country*, by 4-Year Intervals, 1997–2010N=2,725 *Ranked by counts

  14. States with the Greatest Percent of the U.S. Total Pediatric TB Cases, 1993–2010N=18,783

  15. States with Greatest Numbers of Pediatric TB Cases, 1993–2010 Pediatric TB Cases State Number Percent* Rate** Overall U.S. 18,783 6.2 1.8 *Average percent of total state cases that are pediatric, for all years **Time-averaged annual rate per 100,000

  16. States with Greatest Percent of Pediatric TB Cases, 1993–2010 Pediatric TB Cases State Number Percent* Rate** 18,783 Overall U.S. 6.2 1.8 *Average percent of total state cases that are pediatric, for all years **Time-averaged rate per 100,000

  17. States with Greatest Rate of Pediatric TB Cases, 1993–2010 Pediatric TB Cases State Number Percent* Rate** Overall U.S. 18,783 6.2 1.8 *Average percent of total state cases that are pediatric, for all years **Time-averaged rate per 100,000 †D.C. (District of Columbia) is a distinct reporting jurisdiction

  18. Pediatric TB Cases by Case Verification Criterion*, 1993–2010N=18,783 ProviderDiagnosis 24% Laboratory Confirmed 25% Clinical Case 51% *Based on the public health surveillance definition for TB [MMWR 1997:46(No. RR-10):40-41]

  19. Pediatric TB Cases by Case Verification Criterion by Age Group, 1993–2010N=18,783 Laboratory Confirmed Clinical Case Provider Diagnosis

  20. Pediatric TB Cases by Site of Disease, 1993–2010 Any extrapulmonary involvement* (totaling 29.3%) Lymphatic 18.9% Meningeal 3.3% Miliary 1.5% Bone & Joint 1.4% Other 4.2% *Any extrapulmonary involvement which includes cases that are extrapulmonary only and both. Patients may have more than one disease site but are counted in mutually exclusive categories for surveillance purposes.

  21. Pediatric TB Cases by Site of Disease by Age Group, 1993–2010N=18,783 Pulmonary Extrapulmonary Both

  22. Pediatric TB Cases with Any Extrapulmonary Involvement* by Age Group and Selected Sites of Disease, 1993–2010N=18,783 Age < 1 (n=1,862) Age 5–9 (n=4,270) Age 10–14 (n=3,436) Age 1–4 (n=9,215) Site of Disease 28.3% Total 25.0% 30.0% 33.5% *Any extrapulmonary involvement includes extrapulmonary only and both Note: Combine the total extrapulmonary percent shown with the pulmonary percent in slide #21 to obtain 100% for each age group.

  23. Percent of TB Cases in Children Age < 1 Year With Any ExtrapulmonaryInvolvement*, 1993–2010N=1,862 Site of disease U.S.-born Foreign-born Total 24.9% 26.9% *Any extrapulmonary involvement includes extrapulmonary only and both.

  24. Percent of TB Cases in Children Age 1–4 Years With Any ExtrapulmonaryInvolvement*, 1993–2010N=9,215 Site of disease U.S.-born Foreign-born Total 28.9% 25.6% *Any extrapulmonary involvement includes extrapulmonary only and both.

  25. Percent of TB Cases in Children Age 5–9 Years With Any ExtrapulmonaryInvolvement*, 1993–2010N=4,270 Site of disease U.S.-born Foreign-born Total 31.2% 28.0% *Any extrapulmonary involvement includes extrapulmonary only and both.

  26. Percent of TB Cases in Children Age 10–14 Years With Any ExtrapulmonaryInvolvement*, 1993–2010N=3,436 Site of disease U.S.-born Foreign-born Total 35.3% 31.5% *Any extrapulmonary involvement includes extrapulmonary only and both.

  27. Pediatric TB Cases by HIV Status, 1993–2009*N=18,146 • Information on HIV result is not available for the majority of pediatric TB cases (77.6%) • Percent of pediatric TB cases with HIV-positive test results, minimum estimate** (0.9%) • Percent of pediatric cases with HIV-positive test results of those patients with known results (4.2%) *California HIV data through 2004 only; Vermont HIV data through 2006 only. **Pediatric TB cases with positive HIV test results divided by all pediatric TB cases. California only reports positive HIV test results based on TB and AIDS registry matching; all other California TB cases are classified as “Unknown.”

  28. Number and Percent of Culture-Confirmed Pediatric TB Cases with Drug Resistance, 1993–2009 First line drugs are isoniazid, rifampin, pyrazinamide and ethambutol MDR TB = resistance to at least isoniazid and rifampin

  29. Pediatric TB Cases by Use of Directly Observed Therapy (DOT), 1993–2008N=17,445* Percentage Year *Pediatric TB cases with patient alive at diagnosis and started on treatment

  30. Pediatric TB Cases by Treatment Outcome 1993–2008N=17,445* Outcome Cases % Note: Cause of death not recorded in TB case reports *Pediatric TB cases with patient alive at diagnosis and started on treatment **Other includes refused, other, unknown, and missing

  31. Deaths Occurring Among Pediatric TB Cases, by Age Group, 1993–2008N=17,499 Age Group Cases Deaths* % of Cases Note: Cause of death not recorded in TB case reports *Death includes died during therapy or dead at TB diagnosis

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