Slide Set— Epidemiology of Pediatric Tuberculosis in the United
States, 1993–2006
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Slide 1
Epidemiology of Pediatric Tuberculosis in the United States,
1993–2006
Surveillance, Epidemiology, and Outbreak Investigations Branch
Division of Tuberculosis Elimination
Centers for Disease Control and Prevention (CDC)
Slide 2
Pediatric TB—Background
- Definition of pediatric tuberculosis (TB): TB disease in
a person <15 years old
- In 2006,
- 13,779 TB cases were reported among all age groups
- 807 (5.9%) were pediatric
Slide 3
TB Case Definition and Verification
- Incident case of disease
Case verification categories:
- Laboratory confirmed cases-”Gold Standard”
- Positive culture, DNA probe, or nucleic acid amplification
test
- Positive AFB smear when culture not attainable
- Clinical case definition
- Positive tuberculin skin test
- Signs and symptoms of TB disease
- Current treatment for TB disease
- Provider diagnosis:
- - Diagnosed by health care provider
- - Does not fulfill all criteria necessary to meet laboratory
or clinical case definitions
Slide 4
TB Cases, All Ages, by Age Group, 1993–2006
|
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
<15 yrs |
1661 |
1659 |
1536 |
1356 |
1251 |
1077 |
1039 |
964 |
929 |
944 |
912 |
954 |
15-24 yrs |
1823 |
1833 |
1698 |
1637 |
1675 |
1542 |
1518 |
1617 |
1597 |
1497 |
1573 |
1602 |
25-44 yrs |
9587 |
9043 |
8201 |
7564 |
6884 |
6335 |
6063 |
5575 |
5609 |
5288 |
5073 |
4940 |
45-64 yrs |
6197 |
6125 |
5960 |
5572 |
5277 |
4956 |
4858 |
4637 |
4515 |
4182 |
4283 |
4194 |
65+ yrs |
5820 |
5539 |
5328 |
5076 |
4663 |
4377 |
4020 |
3516 |
3293 |
3141 |
2994 |
2811 |
Slide 5
TB Case Rates, All Ages, by Age Group 1993–2006
|
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
Overall US |
9.7 |
9.2 |
8.5 |
7.9 |
7.2 |
6.6 |
6.3 |
5.8 |
5.6 |
5.2 |
5.1 |
4.9 |
4.7 |
4.6 |
<15 yrs |
2.9 |
2.9 |
2.6 |
2.3 |
2.1 |
1.8 |
1.7 |
1.6 |
1.5 |
1.6 |
1.5 |
1.6 |
1.4 |
1.3 |
15-24 yrs |
5 |
5 |
4.6 |
4.4 |
4.5 |
4.1 |
3.9 |
4.1 |
4.0 |
3.7 |
3.8 |
3.8 |
3.7 |
3.6 |
25-44 yrs |
11.5 |
10.7 |
9.7 |
8.9 |
8.0 |
7.4 |
7.1 |
6.6 |
6.6 |
6.3 |
6.0 |
5.9 |
5.6 |
5.6 |
45-64 yrs |
12.4 |
11.9 |
11.3 |
10.2 |
9.4 |
8.5 |
8.0 |
7.4 |
7.0 |
6.3 |
6.2 |
5.9 |
5.7 |
5.4 |
65+ yrs |
17.7 |
16.6 |
15.8 |
14.9 |
13.6 |
12.6 |
11.6 |
10.0 |
9.3 |
8.8 |
8.3 |
7.7 |
7.7 |
7.2 |
Note: Rates presented on a logarithmic scale
Slide 6
Percent of Pediatric TB Cases by Age Group 1993–2006
N=15,946
|
Age < 1 |
Age 1-4 |
Age 5-9 |
Age 10-14 |
Pediatric |
1471 |
7884 |
3691 |
2900 |
Slide 7
Pediatric TB Cases by Age Group 1993–2006
N=15,946
|
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
age < 1 |
156 |
140 |
120 |
102 |
113 |
105 |
97 |
91 |
97 |
101 |
94 |
82 |
81 |
92 |
Age 1-4 |
859 |
856 |
774 |
668 |
621 |
533 |
506 |
453 |
446 |
455 |
454 |
469 |
397 |
393 |
Age 5-9 |
358 |
394 |
393 |
368 |
305 |
243 |
250 |
221 |
208 |
196 |
195 |
203 |
197 |
160 |
Age 10-14 |
288 |
269 |
249 |
218 |
212 |
196 |
186 |
199 |
178 |
192 |
169 |
200 |
182 |
162 |
Slide 8
TB Case Rates by Pediatric Age Groups 1993–2006
N=15,946
|
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
Age < 1 |
4.0 |
3.6 |
3.1 |
2.7 |
3.0 |
2.8 |
2.5 |
2.4 |
2.4 |
2.5 |
2.3 |
2.0 |
2.0 |
2.2 |
Age 1-4 |
5.4 |
5.4 |
4.9 |
4.3 |
4.1 |
3.5 |
3.3 |
3 |
2.9 |
2.9 |
2.9 |
2.9 |
2.4 |
2.4 |
Age 5-9 |
1.9 |
2.1 |
2.1 |
1.9 |
1.5 |
1.2 |
1.3 |
1.1 |
1.0 |
1.0 |
1.0 |
1.0 |
1.0 |
0.8 |
Age 10-14 |
1.6 |
1.4 |
1.3 |
1.1 |
1.1 |
1.0 |
1.0 |
1.0 |
0.9 |
0.9 |
0.8 |
0.9 |
0.9 |
0.8 |
Note: Rates presented on a logarithmic scale
Slide 9
Pediatric TB Cases by Race/Ethnicity 1993–2006
N=15,946
|
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
White, non-Hispanic |
250 |
230 |
184 |
157 |
136 |
137 |
126 |
104 |
87 |
104 |
82 |
77 |
66 |
67 |
Black, non-Hispanic |
559 |
572 |
517 |
515 |
469 |
372 |
345 |
334 |
309 |
329 |
257 |
289 |
264 |
252 |
Hispanic |
640 |
642 |
624 |
512 |
438 |
423 |
432 |
374 |
413 |
400 |
432 |
456 |
397 |
388 |
American Indian/
Alaskan Native |
22 |
31 |
34 |
37 |
29 |
15 |
15 |
27 |
8 |
13 |
13 |
13 |
12 |
9 |
Asian/Pacific Islander |
184 |
181 |
175 |
133 |
178 |
128 |
116 |
122 |
112 |
95 |
123 |
115 |
108 |
89 |
Slide 10
Pediatric TB Case Rates by Race/Ethnicity 1993–2006
N=15,946
|
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
White, non-Hispanic |
0.7 |
0.6 |
0.5 |
0.4 |
0.4 |
0.4 |
0.3 |
0.3 |
0.2 |
0.3 |
0.2 |
0.2 |
0.2 |
0.2 |
Black, non-Hispanic |
6.5 |
6.5 |
5.8 |
5.7 |
5.1 |
4.0 |
3.7 |
3.5 |
3.3 |
3.5 |
2.7 |
3.1 |
2.8 |
2.7 |
Hispanic |
8.3 |
7.9 |
7.4 |
5.8 |
4.7 |
4.4 |
4.3 |
3.5 |
3.8 |
3.5 |
3.7 |
3.8 |
3.2 |
3.1 |
Asian/Pacific Islander |
9.5 |
9.0 |
8.4 |
6.2 |
8.1 |
5.7 |
5.0 |
5.1 |
4.6 |
3.8 |
4.8 |
4.4 |
4.0 |
3.1 |
Rates presented on a logarithmic scale.
American Indian/Alaska Native rate not shown because of small
denominators
Slide 11
TB Case Rates by Pediatric Age Groups U.S.-born and Foreign-born,
1994–2006
N=14,285
|
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
Age < 1, FB |
45.7 |
45.9 |
65.2 |
25.8 |
52.6 |
72.6 |
37.4 |
29.4 |
12.1 |
70.3 |
23.1 |
11.2 |
28.2 |
Age 1-4, FB |
43.6 |
46.1 |
33.1 |
33.7 |
33.8 |
31.8 |
30.0 |
27.0 |
25.2 |
29.9 |
34.0 |
22.5 |
21.2 |
Age 5-9, FB |
23.1 |
16.4 |
14.4 |
12.7 |
10.4 |
16.5 |
10.3 |
14.2 |
10.2 |
12.5 |
11.4 |
10.5 |
6.7 |
Age 10-14, FB |
12.2 |
13.2 |
11.4 |
10.7 |
9.4 |
9.8 |
9.5 |
7.9 |
9.3 |
7.8 |
10.1 |
8.5 |
8.5 |
|
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
Age < 1, USB |
3.3 |
2.9 |
2.4 |
2.8 |
2.3 |
2.3 |
2.1 |
2.2 |
2.5 |
2.6 |
2.1 |
2.0 |
2.1 |
Age 1-4, USB |
4.4 |
4.1 |
3.6 |
3.3 |
2.9 |
2.7 |
2.4 |
2.3 |
2.4 |
2.2 |
2.3 |
2.0 |
2.1 |
Age 5-9, USB |
1.3 |
1.5 |
1.4 |
1.1 |
0.9 |
0.8 |
0.8 |
0.6 |
0.6 |
0.6 |
0.7 |
0.6 |
0.6 |
Age 10-14, USB |
0.8 |
0.7 |
0.6 |
0.6 |
0.6 |
0.5 |
0.5 |
0.5 |
0.5 |
0.4 |
0.5 |
0.4 |
0.4 |
Note: Rates presented on a logarithmic scale. Data not
available before 1994.
USB = U.S.-born, FB=Foreign-born
Slide 12
Number and Percent Foreign-born Pediatric TB Cases, 1993–2006
|
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
2006 |
Foreign-born |
413 |
386 |
352 |
312 |
287 |
249 |
265 |
255 |
269 |
249 |
269 |
280 |
243 |
201 |
U.S.-born |
1232 |
1252 |
1179 |
1030 |
954 |
822 |
763 |
707 |
659 |
690 |
643 |
673 |
613 |
606 |
Percent foreign-born |
24.9 |
23.3 |
22.9 |
23 |
22.9 |
23.1 |
25.5 |
26.5 |
29 |
26.4 |
29.5 |
29.4 |
28.4 |
24.9 |
Slide 13
Foreign-born Pediatric TB Cases by Birth Country* and 4-Year
Interval, 1995–2006
N=3,231
1995-1998 (n) |
1999-2002 (n) |
2003-2006 (n) |
Mexico (467) |
Mexico (375) |
Mexico (323) |
Philippines (118) |
Somalia (79) |
Somalia (65) |
Viet Nam (73) |
Philippines (67) |
Philippines (63) |
Somalia (43) |
Haiti (38) |
Haiti (45) |
Haiti (39) |
Viet Nam (36) |
Viet Nam (37) |
Russia (38) |
Sudan (26) |
India (36) |
Other (422) |
Other (417) |
Other (424) |
*Ranked by counts
Slide 14
States with the Greatest Percent of the National Total Pediatric
TB Cases, 1993–2006
N=15,946
|
California |
Texas |
New York |
Florida |
Illinois |
Georgia |
All Others |
U.S. Total |
25.2 |
11.8 |
8.8 |
5.0 |
5.0 |
4.4 |
39.8 |
Slide 15
States with Greatest Numbers of Pediatric TB Cases, 1993–2006
Pediatric TB Cases
State |
Number |
Percent* |
Rate** |
California |
4,025 |
7.7 |
3.7 |
Texas |
1,874 |
7.3 |
2.7 |
New York |
1,399 |
4.8 |
2.6 |
Florida |
794 |
4.4 |
1.9 |
Illinois |
791 |
6.9 |
2.1 |
Georgia |
700 |
7.8 |
2.8 |
All Others |
6,363 |
5.9 |
1.3 |
Overall U.S. |
15,946 |
6.3 |
1.9 |
*Average percent of total state cases that are
pediatric, for all years
**Time-averaged annual rate per 100,000
Slide 16
States with Highest Percent of Pediatric TB cases, 1993–2006
State |
Number |
Percent* |
Rate** |
Alaska |
125 |
13.0 |
5.7 |
Rhode Island |
72 |
10.4 |
2.6 |
Minnesota |
253 |
9.8 |
1.7 |
Oklahoma |
262 |
9.8 |
2.6 |
Delaware |
52 |
9.7 |
2.4 |
Arizona |
361 |
9.3 |
2.3 |
All Others |
14,821 |
6.1 |
1.9 |
Overall U.S. |
15,946 |
6.3 |
1.9 |
*Average percent of total state cases that
are pediatric, for all years
**Time-averaged annual rate per 100,000
Slide 17
States with Highest Rate of Pediatric TB Cases, 1993–2006
State |
Number |
Percent* |
Rate** |
Alaska |
125 |
13.0 |
5.7 |
D.C.† |
54 |
4.0 |
4.0 |
California |
4,025 |
7.7 |
3.7 |
Georgia |
700 |
7.8 |
2.8 |
Texas |
1,874 |
7.3 |
2.7 |
Arkansas |
204 |
8.2 |
2.6 |
All Others |
8,964 |
5.5 |
1.5 |
Overall U.S. |
15,946 |
6.3 |
1.9 |
*Average percent of total state cases that are pediatric, for
all years
**Time-averaged rate per 100,000
†D.C. (District of Columbia) is a distinct reporting jurisdiction
Slide 18
Pediatric TB Cases by Case Verification Criterion*, 1993–2006
N=15,946
Laboratory Confirmed |
Clinical Case |
Provider Diagnosis |
25% |
51% |
24% |
Slide 19
Pediatric TB Cases by Case Verification Criterion, 1993–2006
N=15,946
Age < 1 n=1,471
Laboratory Confirmed |
Clinical Case |
Provider Diagnosis |
52% |
25% |
23% |
Age 1-4 n=7,784
Laboratory Confirmed |
Clinical Case |
Provider Diagnosis |
20% |
54% |
26% |
Age 5-9 n=3,691
Laboratory Confirmed |
Clinical Case |
Provider Diagnosis |
15% |
59% |
26% |
Age 10-14 n=2,900
Laboratory Confirmed |
Clinical Case |
Provider Diagnosis |
36% |
46% |
18% |
Slide 20
Pediatric TB Cases by Site of Disease, 1993–2006
|
Both |
Extrapulmonary |
Pulmonary |
Site of Disease |
7.0% |
21.9% |
71.1% |
Any extrapulmonary involvement*
(totaling 28.9%) |
Lymphatic |
18.9% |
Meningeal |
3.1% |
Miliary |
1.5% |
Bone & Joint |
1.5% |
Other |
3.9% |
* Any extrapulmonary involvement which includes cases
that are extrapulmonary only and both
Patients may have more than one disease site but are counted in
mutually exclusive categories for
surveillance purposes.
Slide 21
Percent of Pediatric TB Cases by Site of Disease*, 1993–2006
N=15,946
Age <1 n=1,471
|
Pulmonary |
Extrapulmonary |
Both |
Site of Disease |
75.2% |
10.1% |
14.7% |
Age 1-4 n=7,884
|
Pulmonary |
Extrapulmonary |
Both |
Site of Disease |
72.1% |
20.7% |
7.2% |
Age 5-9 n=3,691
|
Pulmonary |
Extrapulmonary |
Both |
Site of Disease |
70.1% |
25.5% |
4.4% |
Age 10-14 n=2,900
|
Pulmonary |
Extrapulmonary |
Both |
Site of Disease |
67.1% |
27.0% |
5.9% |
Slide 22
Percent of Pediatric TB Cases with Any Extrapulmonary Involvement*
by Age Group and Selected Sites of Disease, 1993–2006
N=15,946
Site of Disease |
Age < 1
(n=1,471) |
Age 1-4
(n=7,884) |
Age 5-9
(n=3,691) |
Age 10-14
(n=2,900) |
Lymphatic |
8.0 |
19.3 |
22.3 |
19.2 |
Meningeal |
7.5 |
3.5 |
1.4 |
1.8 |
Miliary |
5.6 |
1.2 |
0.6 |
1.2 |
Bone & Joint |
0.3 |
1.3 |
1.7 |
2.4 |
Other |
3.4 |
2.6 |
3.9 |
8.3 |
Total |
24.8 |
27.9 |
29.9 |
32.9 |
*Any extrapulmonary involvement includes extrapulmonary only
and both
Note: Combine the total extrapulmonary percent shown with the
pulmonary percent in slide #21 to obtain 100% for each age
group.
Slide 23
Percent of TB Cases in Children Age < 1 Year With Any Extrapulmonary
Involvement, 1993–2006
N=1,471
Site of Disease |
U.S.-born |
Foreign-born |
Lymphatic |
7.2% |
17.7% |
Meningeal |
7.8% |
3.5% |
Miliary |
5.8% |
3.5% |
Bone & Joint |
0.3% |
0.9% |
Other |
3.4% |
1.8% |
Total |
24.5% |
27.4%* |
*Any extrapulmonary involvement includes extrapulmonary only
and both
Slide 24
Percent of TB Cases in Children Age 1 - 4 Years With Any Extrapulmonary
Involvement, 1993–2006
N=7,884
Site of Disease |
U.S.-born |
Foreign-born |
Lymphatic |
19.4% |
19.0% |
Meningeal |
3.8% |
2.0% |
Miliary |
1.3% |
1.0% |
Bone & Joint |
1.1% |
2.0% |
Other |
2.7% |
2.0% |
Total |
28.3%* |
26.0%* |
*Any Extrapulmonary involvement includes extrapulmonary only
and both
Slide 25
Percent of TB Cases in Children Age 5 - 9 Years With Any Extrapulmonary
Involvement, 1993–2006
N=3,691
Site of Disease |
U.S.-born |
Foreign-born |
Lymphatic |
23.1% |
20.8% |
Meningeal |
1.4% |
1.0% |
Miliary |
0.6% |
0.6% |
Bone & Joint |
1.6% |
2.1% |
Other |
4.1% |
3.8% |
Total |
30.8%* |
28.3%* |
*Any Extrapulmonary involvement includes extrapulmonary only
and both
Slide 26
Percent of TB Cases in Children Age 10-14 Years With Any Extrapulmonary
Involvement, 1993–2006
N=2,900
Site of Disease |
U.S.-born |
Foreign-born |
Lymphatic |
20.4% |
18.1% |
Meningeal |
1.6% |
1.8% |
Miliary |
1.5% |
0.8% |
Bone & Joint |
2.0% |
2.8% |
Other |
9.0% |
7.3% |
Total |
34.5%* |
30.8%* |
*Any Extrapulmonary involvement includes extrapulmonary only
and both
Slide 27
Pediatric TB Cases by HIV Status, 1993–2005*
N=14,990
- Information on HIV result is not available for the majority
of pediatric TB cases (80.7%)
- Percent of pediatric TB cases with HIV-positive test results, minimum estimate** (1.0%)
- Percent of pediatric cases with HIV-positive test results
of those patients with known results (5.1%)
*California HIV data through 2004 only
**Pediatric TB cases with positive HIV test results divided by
all pediatric TB cases .
California only reports positive HIV test results based on TB
and AIDS registry matching; all other California TB
cases are classified as “Unknown.”
Slide 28
Number and Percent of Culture-confirmed Pediatric TB Cases with
Drug Resistance, 1993–2005
|
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
2005 |
Resistance to any 1st
line drug |
31.0 |
43.0 |
31 |
38 |
38 |
28 |
28 |
27 |
38 |
33 |
30 |
39 |
38 |
Percent with resistance
to any 1st line drug |
9.7 |
13.3 |
10.3 |
12.7 |
13.4 |
12.2 |
12.3 |
11.3 |
15 |
14.7 |
14.6 |
17 |
18.1 |
MDR TB |
6 |
6 |
4 |
6 |
4 |
6 |
5 |
1 |
4 |
4 |
3 |
1 |
5 |
Percent with MDR TB |
1.9 |
1.9 |
1.3 |
2.0 |
1.4 |
2.7 |
2.2 |
0.4 |
1.6 |
1.8 |
1.5 |
0.4 |
2.4 |
First line drugs are Isoniazid, Rifampin, Pyrazinamide and
Ethambutol
MDR TB = resistance to at least Isoniazid and Rifampin
Slide 29
Pediatric TB Cases by Use of Directly Observed Therapy (DOT),
1993–2004
N=14,233*
|
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
2000 |
2001 |
2002 |
2003 |
2004 |
DOT only |
22.1 |
26.9 |
40.9 |
47.4 |
55.3 |
58.3 |
56.5 |
61.5 |
61.5 |
64.4 |
62.9 |
65 |
Self-Administered
only |
64.3 |
51.0 |
34.5 |
28.2 |
20.0 |
17.1 |
15.2 |
13.4 |
11.3 |
7.6 |
6.4 |
6.3 |
DOT and
Self-Administered |
12.1 |
19.1 |
22.3 |
22.1 |
22.5 |
23.4 |
26 |
24 |
25.3 |
26.1 |
29.3 |
25.5 |
*Pediatric TB cases with patient alive at diagnosis and
started on treatment
Slide 30
Pediatric TB Cases by Treatment Outcome 1993–2004
N=14,233*
Outcome |
Cases |
% |
Completed treatment |
13,459 |
94.6 |
Moved |
352 |
2.5 |
Lost to follow-up |
138 |
1.0 |
Died |
78 |
0.6 |
Other** |
206 |
1.3 |
Note: Cause of death not recorded in TB case reports
*Pediatric TB cases with patient alive at diagnosis and started
on treatment
**Other includes refused, other, unknown and missing
Slide 31
Deaths Occurring Among Pediatric TB Cases, by Age Group, 1993–2004
N=14,282
Age Group |
Cases |
Deaths** |
% of Cases |
Age<1 |
1298 |
26 |
2.0 |
Age 1-4 |
7094 |
46 |
0.6 |
Age 5-9 |
3334 |
20 |
0.6 |
Age 10-14 |
2556 |
20 |
0.8 |
Note: Cause of death not recorded in TB case reports
**Death includes died during therapy or dead at TB diagnosis