Epidemiology of tuberculosis among children and adolescents in the USA, 2007-17: an analysis of national surveillance data

Abstract

Background: Understanding tuberculosis epidemiology among children and adolescents informs treatment and prevention efforts, and efforts to eliminate disparities in tuberculosis incidence and mortality. We sought to describe the epidemiology of children and adolescents with tuberculosis disease in the USA, including tuberculosis incidence rates by parental country of birth and for US territories and freely associated states, which have not been previously described.

Methods: We analysed data for children aged younger than 15 years and adolescents aged 15-17 years with tuberculosis disease reported to the National Tuberculosis Surveillance System during 2007-17, and calculated tuberculosis incidence rates using population estimates from the US Census Bureau.

Findings: During 2010-17, 6072 tuberculosis cases occurred among children and adolescents; of these, 5175 (85%) of 6072 occurred in the 50 US states or the District of Columbia and 897 (15%) of 6072 in US-affiliated islands. In US states, 3520 (68%) of 5175 cases occurred among US-born people overall, including 2977 (76%) of 3896 children and 543 (42%) of 1279 adolescents. The incidence rate among children and adolescents was 1·0 per 100 000 person-years during 2007-17 and declined 47·8% (95% CI -51·4 to -44·1) during this period. We observed disproportionately high tuberculosis rates among children and adolescents of all non-white racial or ethnic groups, people living in US-affiliated islands, and children born in or with parents from tuberculosis-endemic countries.

Interpretation: Overall, tuberculosis incidence among children and adolescents in the USA is low and steadily declining, but additional efforts are needed to eliminate disparities in incidence and mortality.

Funding: US Centers for Disease Control and Prevention.

Figure 1.. Characteristics of children aged <15 years with tuberculosis (TB), reported in U.S. States and District of Columbia, 2010–2017

Categories are hierarchical in the order listed in the legend above (i.e., category ‘lived or traveled outside the U.S. for ≥ 2 months’ does not include children and adolescents identified through contact tracing or those born outside the U.S.). Starred (*) characteristics are currently covered under U.S. targeted testing guidelines. The category, “none of the above characteristics recorded” includes n=136 (3.5%) children for whom nativity of both parents was unknown or missing, and n=119 (3.1%) children who had one U.S.–born parent and one parent of unknown or missing nativity status.

Figure 2.. Number of tuberculosis (TB) cases and TB rates by country of birth among non-U.S.–born children aged <15 years and by parental country of birth among U.S.-born children with at least one non-U.S.–born parent in U.S. States and District of Columbia, 2010–2017

Countries are shown by descending case count (bars) within U.S. Census Bureau world regions (Latin America, Asia, Africa, and Oceania); All countries with at least 25 children who were non-U.S.–born or had non-U.S.–born parents from that country (total bar height) are shown. For U.S.-born children with at least one non-U.S.–born (non-USB) parent, includes children who have two non-U.S.–born parents, children with one non-U.S.- and one U.S.-born parent, and children with one non-U.S.–born parent and one parent with unknown nativity. For the n=100 children with two non-U.S.–born parents from different countries, children are counted twice for each country of birth for their parents (e.g., for a child with one parent born in El Salvador and one parent born in Ecuador, the child will appear in the calculations and totals for both El Salvador and Ecuador) Abbreviations: USB=U.S.-born;