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The Changing Landscape of Childhood Tuberculosis in the United Kingdom

A Retrospective Cohort (2000–2015)

Mohiyuddin, Tehreem, MSc*; Seddon, James A., PhD; Thomas, H. Lucy, MFPH*; Lalor, Maeve K., PhD*,‡

The Pediatric Infectious Disease Journal: May 2019 - Volume 38 - Issue 5 - p 470–475
doi: 10.1097/INF.0000000000002200
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Background: The epidemiology of tuberculosis (TB) is changing in the United Kingdom and globally. Childhood TB is a key indicator of recent transmission and provides a marker of wider TB control. We describe the recent epidemiology of childhood TB in the United Kingdom, how this compares to TB in adults, and document changes with time.

Methods: TB cases notified in the United Kingdom between 2000 and 2015 were categorized as children (<15 years of age) or adults (≥15 years of age). Descriptive analyses were carried out on demographic, clinical and microbiologic data. We carried out logistic regressions to identify risk factors associated with children having no microbiologic confirmation.

Results: In the study period, 6293 TB cases (5%) in the United Kingdom were notified in children. Childhood TB incidence declined from 487 cases in 2000 (3.4 per 100,000) to 232 cases (2.0 per 100,000) in 2015. The majority (68%) of children with TB were UK born, with a high proportion of Pakistani (24%) and Black-African (22%) ethnicity. Sixty-four percent of children had pulmonary disease. Culture confirmation was low (24%). Children who were younger, UK born and those with extrapulmonary disease were less likely to have microbiologically confirmed TB. A high proportion (87%) of children completed treatment at last-recorded outcome, with few deaths (39 cases; 0.7%).

Conclusions: The incidence of TB in children in the United Kingdom has decreased in the past 16 years, with the majority of children completing TB treatment. Ongoing monitoring of childhood TB will provide a measure of the effectiveness of the national TB program.

From the *TB Section, National Infection Service, Public Health England

Centre for International Child Health, Imperial College London

Institute for Global Health, University College London, London, United Kingdom.

Accepted for publication September 13, 2018.

The authors have no funding or conflicts of interest to disclose.

This study was designed by T.M., J.A.S., H.L.T. and M.K.L. Data analysis and the first draft were conducted by T.M.. All authors commented and revised the article, and approved the final draft.

Ethical Approval: Public Health England has authority under the Health and Social Care Act 2012 to hold and analyze national surveillance data for public health and research purposes.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Tehreem Mohiyuddin, MSc, TB Section, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ. E-mail: tehreem.mohiyuddin@phe.gov.uk.

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