Underuse of effective measures to prevent and manage pediatric tuberculosis in the United States

Arch Pediatr Adolesc Med. 2008 May;162(5):426-31. doi: 10.1001/archpedi.162.5.426.


Objective: To characterize problems with prevention and management of pediatric tuberculosis (TB) and latent TB infection (LTBI).

Design: 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.

Setting: Four areas of the United States.

Participants: 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.

Main outcome measures: 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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Antitubercular Agents / therapeutic use
  • Case Management
  • Child, Preschool
  • Communicable Disease Control / statistics & numerical data*
  • Emigration and Immigration
  • Humans
  • Mycobacterium tuberculosis / isolation & purification
  • Risk Factors
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / epidemiology
  • Tuberculosis, Pulmonary / prevention & control*
  • Tuberculosis, Pulmonary / transmission
  • United States / epidemiology


  • Antitubercular Agents