Abstract

Objective: To describe the recent trends in demographic, clinical or microbiological characteristics and outcome of treatment of paediatric cases.

Design: National Surveillance Study

Setting: England and Wales

Patients: All children under the age of 16 years reported with tuberculosis to the national enhanced surveillance system between 1999 and 2006 were included. Main outcome measures: Proportions, and rates of disease, by demographic characteristics, site of disease, diagnostic delay, culture confirmation, species, drug susceptibility and treatment outcome.

Results: There were 3563 cases of tuberculosis in children reported between 1999 and 2006. The incidence rate remained stable around 4.3 per 100,000 (95% CI 4.1-4.4). Patients born outside the UK had a tuberculosis rate higher than UK born children (37 per 100,000 vs 2.5 per 100,000) and this rate increased over the period. Rates in the black African ethnic group were highest at 88 per 100,000. 60% of children had pulmonary disease, the commonest presentation, however, only 948 (27%) had culture confirmed tuberculosis. The median time to diagnosis from onset of symptoms is 37 days (IQR 12 - 89). The proportion of cases with rifampicin, isoniazid and multi drug resistant isolates was 2.4%, 9.3% and 2.3% respectively. 88% of children completed treatment and less than 1% died.

Conclusions: Overall rates of tuberculosis in children have remained stable with the majority completing treatment. Rates are, however, highest in the non-UK born, particularly in certain ethnic minority groups. Levels of drug resistance are also high.