ORIGINAL ARTICLE

Tuberculosis in New Zealand, 1992–2001: a resurgence

S Howie¹, L Voss², M Baker³, L Calder⁴, K Grimwood⁵, C Byrnes¹

¹ Division of Paediatrics, University of Auckland, Auckland, New Zealand
² Starship Children’s Health, Auckland, New Zealand
³ Institute of Environmental Science and Research, Porirua, and Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
⁴ Public Health, Auckland District Health Board, Auckland, New Zealand
⁵ Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand

Correspondence to:
Correspondence to:
S R C Howie
Medical Research Council Laboratories, PO Box 273, Banjul, The Gambia; showie{at}mrc.gm

Objective: To describe the recent epidemiology and clinical features of paediatric tuberculosis (TB) in New Zealand (NZ).

Methods: A retrospective review was conducted of clinical, laboratory, and radiology records of children <16 years old diagnosed with TB between January 1992 and June 2001 in nine NZ health districts.

Results: A total of 274 patients <16 years old were identified; the average annual TB rate was 4.8 per 100 000. Rates rose over time reaching a peak of 10.1 in 1999. Rates were highest in under-5 year olds, at 6.2 per 100 000, and varied by ethnicity: African 575.2, Pacific Island 15.2, Maori 6.4, Asian 5.6, and European 0.6. Seventy two cases (26%) were foreign born. Thirty six per cent of cases were not detected until they presented with symptoms and of these 44% had no known TB contact. Most cases were identified by contact tracing (48%) or immigrant screening (11%); 43% were part of outbreaks. Miliary TB or meningitis occurred in 8% of patients, two of whom died. Drug resistance was found in 7% of culture positive cases and no HIV co-infection was found.

Conclusions: A resurgence of TB occurred among children in NZ between 1992 and 2001 predominantly involving non-European and immigrant groups. Despite established contact tracing and immigrant screening programmes, many cases were part of outbreaks, remained unidentified until symptoms arose, or had no known TB contact. These findings point to an unrecognised burden of adult disease, ongoing community transmission, and missed opportunities for prevention. Further study is required to confirm these hypotheses.

Abbreviations: HIV, human immunodeficiency virus; NZ, New Zealand; NZDep96, New Zealand Deprivation Index; TB, tuberculosis

Keywords: children; epidemiology; New Zealand; paediatric; tuberculosis

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Atoms

Howard Bauchner
Arch. Dis. Child. 2005 90: 1101. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Schaaf, H. S., Marais, B. J., Hesseling, A. C., Brittle, W., Donald, P. R. (2009). Surveillance of Antituberculosis Drug Resistance Among Children From the Western Cape Province of South Africa--An Upward Trend. AJPH 99: 1486-1490 [Abstract] [Full Text]  
• Wang, W., Jiang, Q., Abdullah, A. S. M., Xu, B. (2007). Barriers in accessing to tuberculosis care among non-residents in Shanghai: a descriptive study of delays in diagnosis. Eur J Public Health 17: 419-423 [Abstract] [Full Text]