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Epidemiology, clinical features and outcomes of incident tuberculosis in children in Canada in 2013–2016: results of a national surveillance study
  1. Shaun K Morris1,2,3,
  2. Ryan J P Giroux2,3,
  3. Raquel Consunji-Araneta4,
  4. Kristoffor Stewart5,
  5. Maureen Baikie6,
  6. Fatima Kakkar7,
  7. David Zielinski8,
  8. Alena Tse-Chang9,10,
  9. Victoria J Cook11,12,
  10. Dina A Fisher13,
  11. Marina I Salvadori14,15,
  12. Jeffrey M Pernica16,
  13. Laura J Sauve12,17,
  14. Charles Hui18,
  15. Amber Miners19,
  16. Gonzalo G Alvarez20,21,
  17. Assaad Al-Azem22,23,
  18. Victor Gallant24,
  19. Barbara Grueger13,
  20. Ray Lam1,2,
  21. Joanne M Langley25,26,
  22. Nicole Radziminski27,
  23. Elizabeth Rea28,
  24. Sam Wong9,27,
  25. Ian Kitai1,2
  1. 1Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2University of Toronto, Toronto, Ontario, Canada
  3. 3The Hospital for Sick Children, Toronto, Ontario, Canada
  4. 4University of Manitoba, Winnipeg, Manitoba, Canada
  5. 5Saskatchewan Infectious Disease Care Network, Saskatoon, Saskatchewan, Canada
  6. 6Government of Nunavut, Iqaluit, Nunavut, Canada
  7. 7Pediatric Infectious Diseases, CHU Sainte-Justine, Montreal, Quebec, Canada
  8. 8Division of Respiratory Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
  9. 9University of Alberta, Edmonton, Alberta, Canada
  10. 10Alberta Health Services, Edmonton, Alberta, Canada
  11. 11British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
  12. 12The University of British Columbia, Vancouver, British Columbia, Canada
  13. 13University of Calgary, Calgary, Alberta, Canada
  14. 14London Health Sciences Centre Children's Hospital, London, Ontario, Canada
  15. 15Public Health Agency of Canada, Ottawa, Ontario, Canada
  16. 16Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  17. 17British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
  18. 18Childrens Hosp Eastern Ontario, Ottawa, Ontario, Canada
  19. 19Qikiqtani General Hospital, Iqaluit, Nunavut, Canada
  20. 20Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  21. 21University of Ottawa, Ottawa, Ontario, Canada
  22. 22Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
  23. 23University of Saskatchewan, Saskatoon, Saskatchewan, Canada
  24. 24Health Canada, Ottawa, Ontario, Canada
  25. 25Dalhousie University, Halifax, Nova Scotia, Canada
  26. 26IWK Health Centre, Halifax, Nova Scotia, Canada
  27. 27Stanton Territorial Hospital, Yellowknife, Northwest Territories, Canada
  28. 28Toronto Public Health, Toronto, Ontario, Canada
  1. Correspondence to Dr Shaun K Morris, Infectious Diseases, The Hospital for Sick Children, Toronto, Canada; shaun.morris{at}


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.

  • epidemiology
  • data collection

Data availability statement

Data are available upon reasonable request.

Statistics from

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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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