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Tuberculosis (TB) continues to be one of the most devastating and widespread infections in the world. It is estimated that in 2004 there were 8.9 million new cases of TB globally.1 In general, children make up only a small proportion of cases, but in some high-incidence countries up to 15% of all TB cases occur in children.2 In June 2005 the World Health Organization (WHO) approved a new Stop TB Strategy with the aim of dramatically reducing the global burden of TB by 2015.3 Their intention is to cure at least 85% of sputum smear-positive cases and reduce the prevalence of and deaths due to TB by 50% relative to the rates in 1990.
The WHO Global tuberculosiscontrol report shows that the greatest burden of TB is in sub-Saharan Africa and Asia, with TB case notifications in the WHO European Region constituting less than 10% of worldwide notifications.1 While notifications are an excellent source of information on adult disease, an accurate description of the burden of TB in children is very difficult to obtain. The WHO notification criteria include only cases that are sputum smear positive. Fewer than 15% of children with culture-proven TB will be sputum smear positive, with the result that only a small percentage of children with TB will be represented in the data. The quality of information provided to the WHO can also vary and in many countries surveillance data are often unreliable due to poor diagnostic facilities and reporting systems. Because of these issues the International Union Against Tuberculosis and Lung Disease has stated that reliable information on the incidence of TB in childhood can only be obtained in developed countries, which have better diagnostic and reporting systems.4
In Europe there is a huge disparity in the rates of …
Competing interests: None.