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Epidemiology of Pediatric Tuberculosis in the United States, 1993 – 2006

Epidemiology of Pediatric Tuberculosis in the United States, 1993 – 2006. Surveillance, Epidemiology, and Outbreak Investigations Branch Division of Tuberculosis Elimination Centers for Disease Control and Prevention (CDC). Pediatric TB — Background.

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Epidemiology of Pediatric Tuberculosis in the United States, 1993 – 2006

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  1. Epidemiology of Pediatric Tuberculosis in the United States, 1993–2006 Surveillance, Epidemiology, and Outbreak Investigations Branch Division of Tuberculosis Elimination Centers for Disease Control and Prevention (CDC)

  2. Pediatric TB—Background • Definition of pediatric tuberculosis (TB):TB disease in a person <15 years old • In 2006, • 13,779 TB cases were reported among all age groups • 807 (5.9%) were pediatric

  3. TB Case Definition and Verification • Incident case of disease • Case verification categories: 1) Laboratory confirmed cases-”Gold Standard” - Positive culture, DNA probe, or nucleic acid amplification test - Positive AFB smear when culture not attainable 2) Clinical case definition - Positive tuberculin skin test - Signs and symptoms of TB disease - Current treatment for TB disease 3) 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, 1993–2006 TB Cases Year

  5. TB Case Rates, All Ages, by Age Group1993–2006 TB Case Rate per 100,000 Year Note: Rates presented on a logarithmic scale

  6. Percent of Pediatric TB Cases by Age Group1993–2006N=15,946

  7. Pediatric TB Cases by Age Group 1993–2006N=15,946 TB Cases Year

  8. TB Case Rates by Pediatric Age Groups 1993–2006N=15,946 TB Case Rate per 100,000 Year Note: Rates presented on a logarithmic scale

  9. Pediatric TB Cases by Race/Ethnicity 1993–2006N=15,946 Pediatric TB Cases Year

  10. Pediatric TB Case Rates by Race/Ethnicity 1993–2006N=15,946 TB Case Rate per 100,000 Rates presented on a logarithmic scale. American Indian/Alaska Native rate not shown because of small denominators

  11. TB Case Rates by Pediatric Age GroupsU.S.-born and Foreign-born, 1994–2006N=14,285 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

  12. Number and Percent Foreign-born Pediatric TB Cases, 1993–2006 Percent Number of Pediatric TB Cases

  13. 1995–1998 (n) 1999–2002 (n) 2003–2006 (n) Foreign-born Pediatric TB Cases by Birth Country* and 4-Year Interval, 1995–2006N=3,231 *Ranked by counts

  14. States with the Greatest Percent of the National Total Pediatric TB Cases, 1993–2006N=15,946

  15. States with Greatest Numbers of Pediatric TB Cases, 1993–2006 Pediatric TB Cases State Number Percent* Rate** Overall U.S. 15,946 6.3 1.9 *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, 1993–2006 Pediatric TB Cases State Number Percent* Rate** Overall U.S. 15,946 6.3 1.9 *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, 1993–2006 Pediatric TB Cases State Number Percent* Rate** 6.3 1.9 Overall U.S. 15,946 *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*, 1993–2006N=15,946 Laboratory confirmed 25% Provider Diagnosis 24% Clinical Case Definition 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, 1993–2006N=15,946 Laboratory Confirmed Clinical Case Provider Diagnosis

  20. Pediatric TB Cases by Site of Disease, 1993–2006 Any extrapulmonary involvement* (totaling 28.9%) Lymphatic 18.9% Meningeal 3.1% Miliary 1.5% Bone & Joint 1.5% Other 3.9% *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. Percent of Pediatric TB Cases by Site of Disease*, 1993–2006N=15,946 Pulmonary Extrapulmonary Both

  22. Percent of Pediatric TB Cases with Any Extrapulmonary Involvement* by Age Group and Selected Sites of Disease, 1993–2006N=15,946 Age < 1 (n=1,471) Age 1-4 (n=7,884) Age 5-9 (n=3,691) Age 10-14 (n=2,900) Site of Disease Total 24.8 27.9 29.9 32.9 *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 Extrapulmonary Involvement, 1993–2006N=1,471 Site of disease U.S.-born Foreign-born Total 24.5%* 27.4%* *Any extrapulmonary involvement includes extrapulmonary only and both

  24. Percent of TB Cases in Children Age 1 - 4 Years With Any Extrapulmonary Involvement, 1993–2006N=7,884 Site of disease U.S.-born Foreign-born Total 28.3%* 26.0%* *Any Extrapulmonary involvement includes extrapulmonary only and both

  25. Percent of TB Cases in Children Age 5 - 9 Years With Any Extrapulmonary Involvement, 1993–2006N=3,691 Site of disease U.S.-born Foreign-born Total 30.8%* 28.3%* *Any Extrapulmonary involvement includes extrapulmonary only and both

  26. Percent of TB Cases in Children Age 10-14 Years With Any Extrapulmonary Involvement, 1993–2006N=2,900 Site of disease U.S.-born Foreign-born Total 34.5%* 30.8%* *Any Extrapulmonary involvement includes extrapulmonary only and both

  27. Pediatric TB Cases by HIV Status, 1993–2005*N=14,990 • Information on HIV result is not available for the majority of pediatric TB cases (80.7%) • Percent of pediatric TB cases with HIV-positive test results, minimum estimate** (1.0%) • Percent of pediatric cases with HIV-positive test results of those patients with known results (5.1%) *California HIV data through 2004 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, 1993–2005 • 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), 1993–2004N=14,233* Percentage Year *Pediatric TB cases with patient alive at diagnosis and started on treatment

  30. Pediatric TB Cases by Treatment Outcome 1993–2004N=14,233* 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, 1993–2004N=14,282 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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