Purpose Childhood tuberculosis disease is difficult to diagnose and manage and is an under-recognised cause of morbidity and mortality. Reported data from Canada do not focus on childhood tuberculosis or capture key epidemiologic, clinical and microbiologic details. The purpose of this study was to assess demographics, presentation and clinical features of childhood tuberculosis in Canada.
Methods We conducted prospective surveillance from 2013 to 2016 of over 2700 paediatricians plus vertical tuberculosis programmes for incident tuberculosis disease in children younger than 15 years in Canada using the Canadian Paediatric Surveillance Program (CPSP).
Results In total, 200 cases are included in this study. Tuberculosis was intrathoracic in 183 patients of whom 86% had exclusively intrathoracic involvement. Central nervous system tuberculosis occurred in 16 cases (8%). Fifty-one per cent of cases were hospitalised and 11 (5.5%) admitted to an intensive care unit. Adverse drug reactions were reported in 9% of cases. The source case, most often a first-degree relative, was known in 73% of cases. Fifty-eight per cent of reported cases were Canadian-born Indigenous children. Estimated study rates of reported cases (per 100 000 children per year) were 1.2 overall, 8.6 for all Indigenous children and 54.3 for Inuit children.
Conclusion Childhood tuberculosis may cause significant morbidity and resource utilisation. Key geographies and groups have very high incidence rates. Elimination of childhood tuberculosis in Canada will require well-resourced community-based efforts that focus on these highest risk groups.
- data collection
Data availability statement
Data are available upon reasonable request.
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Contributors SKM and IK conceived the study and wrote the original protocol. SKM wrote the first draft of the manuscript. RJPG conducted statistical analyses. All authors played a role in data collection, critically revised the manuscript and approved the final version.
Funding This work was funded by the Public Health Agency of Canada through the Canadian Paediatric Surveillance Program and a grant from Pediatric Consultants, Hospital for Sick Children. SKM was the recipient of a Career Development Award from the Canadian Child Health Clinician Scientist Program (CCHCSP). RJPG received funding from the SickKids Social Pediatrics Program.
Competing interests JML holds the CIHR-GSK Chair in Pediatric Vaccinology at Dalhousie University.
Provenance and peer review Not commissioned; externally peer reviewed.
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