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June 2006

Racial and Ethnic Disparities in Pediatric Tuberculosis in North Carolina

Author Affiliations

Author Affiliations: Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center (Drs Stout and Dukes Hamilton), and Duke University School of Medicine (Dr Saharia), Durham; Tuberculosis Control Program, Wake County Department of Health and Human Services (Dr Stout), and North Carolina Tuberculosis Control Program, Communicable Disease Branch, Division of Public Health, Department of Health and Human Services (Dr Dukes Hamilton), Raleigh; School of Public Health (Dr Saharia) and Department of Preventive Medicine (Dr Nageswaran), The University of North Carolina at Chapel Hill; and Division of Infectious Diseases, Department of Pediatrics, Carolinas Medical Center, Charlotte (Dr Ahmed), NC. Dr Saharia is now in the Internal Medicine–Pediatrics Residency Program at Yale University, New Haven, Conn.

Arch Pediatr Adolesc Med. 2006;160(6):631-637. doi:10.1001/archpedi.160.6.631

Objectives  To investigate an increase in active pediatric tuberculosis (TB) cases in North Carolina from 9 cases in 2001 to 32 cases in 2002, and to pilot test a screening tool for detection of latent TB infection in children.

Design  Retrospective cohort and cross-sectional study.

Setting  State of North Carolina and a county public health department pediatric clinic.

Participants  Children younger than 15 years with TB in North Carolina from January 1, 1994, to December 31, 2002, and children younger than 21 years initially seen in a primary care public health department pediatric clinic from July 16, 2004, to December 8, 2004.

Interventions  We reviewed medical records for 180 children (<15 years) with active TB reported in North Carolina. We subsequently initiated a screening project at a county public health department pediatric clinic.

Main Outcome Measures  Incidence of TB and prevalence of latent TB infection.

Results  One hundred eighty pediatric TB cases were reported from 1994 to 2002. Compared with 0.2 case per 100 000 non-Hispanic white children, the incidence rates were 3.0 cases per 100 000 non-Hispanic black children (P = .003) and 4.5 cases per 100 000 Hispanic children (P = .01); 88.3% of pediatric patients with TB were nonwhite. The screening project detected 2 cases of latent TB infection among 864 US-born children of foreign-born parents.

Conclusions  The burden of pediatric TB is almost entirely borne by black and Hispanic children in North Carolina. Tuberculin skin testing of US-born children of foreign-born parents is of low yield; more efficient screening strategies are necessary.