The Status of TB in Children

Tuberculosis risk for children may depend on where their parents were born

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) Pediatricians ask many questions at yearly check ups. There’s one question they might need to add to the list: Where were the child’s parents born?

A recent study showed that where children’s parents were born may often be important in determining a child’s risk for a tuberculosis (TB) infection.

The study found that children with international backgrounds have higher rates of TB infection than those born in the United States with US-born parents.

"Consult with a pediatrician when your child is sick."

Carla A. Winston, PhD, MA, from the Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), led the study to find out what children and adolescents diagnosed with TB in the US had in common.

In order to carry out this research, the authors used the US National TB Surveillance System. This is a database run by the CDC that collects detailed information on each reported TB case in the US. For children, it is also reports which country their caretakers come from or if they have spent a lot of time outside the US.

The researchers found records for 2,660 children under the age of 18 with a verified case of TB. The cases studied occurred between January of 2008 and December of 2010.

The study found that four groups of children had the highest rates of TB and should be targeted for prevention efforts: US-born children with foreign-born parents, foreign-born children with US-born parents, foreign-born adolescents and US-born children traditionally at risk for TB due to documented exposure to a TB patient.

Of TB cases among children and adolescents, the researchers found 31 percent were foreign-born and 69 percent were born in the US.

More than half of the TB patients born in the US were Hispanic while only 30 percent of foreign-born TB-affected children were Hispanic.

Just over one-third of foreign-born patients were Asian or Pacific Islander compared with 13 percent of the US-born patients.

Non-Hispanic black patients made up 25 percent of US-born and 30 percent of foreign-born patients.

The most common countries child and adolescent TB patients were born in were Mexico, the Philippines, Ethiopia, Haiti, Burma, Somalia, Vietnam, China and India.

The study authors found 66 percent of the children with TB in the database had a foreign-born parent. In comparison, only 18 percent of the general US-born population younger than 18 years had TB.

The majority of the foreign-born parents of these TB-infected children were from Mexico or Central America.

Of the US-born children and adolescents with TB, 52 percent were Hispanic. In comparison, only 19 percent of all US-born patients (child and adult) with TB were Hispanic. Non-Hispanic Asian and black persons also had a higher rate of TB infection and having children with TB, compared to other foreign-born patients with TB.

Researchers found that among the foreign-born TB patients younger than age 18, the majority were adolescents diagnosed after many years of residence in the US.

“We estimate that three-quarters of pediatric patients with TB in the United States have potential TB exposures through foreign-born parents or residence outside the United States,” the researchers wrote.

Given this elevated risk for children with international backgrounds, healthcare workers may need to ask not only where the child was born but also where the parents were born in order to not miss important TB risk factors.

The number of TB cases among children and adolescents in the US went down from 977 in 2008 to 865 in 2009 and 818 in 2010. The researchers said that though this was a positive trend, TB detection should still be targeted for children from the four groups of concern.

“Continued attention to TB prevention among children and adolescents is critical to sustaining these declines and accelerating progress toward achieving a TB-free generation,” wrote the researchers.

The study was published on November 26 in the journal Pediatrics. Both researchers are employed by the CDC. No funding was received for the study. The study authors report no conflicts of interest.

Reviewed by: 
Review Date: 
December 5, 2012
Last Updated:
January 17, 2013