North Carolina Kids Still at Risk for Tuberculosis

Duke University Medical Center
Sunday, 23 May 2004

Tuberculosis continues to strike children in North Carolina, with minorities and children under 5 years old affected most often and most severely, according to a Duke University Medical Center study.

The analysis of 180 pediatric TB cases shows North Carolina is still far from reaching the federal Healthy People 2010 goal of virtual elimination of tuberculosis infection -- one TB case per 1 million residents.

Although pediatric incidence rates have decreased overall since 1994, the proportion of TB cases in Hispanic, foreign-born immigrants is quickly rising. Between 1994 and 1996, 18 percent of all pediatric TB cases were in this group. The percentage in Hispanic, foreign-born immigrants rose to 36 percent of all cases between 2000 and 2002. African-American children continue to be disproportionately affected by tuberculosis, accounting for 63 percent of the 180 pediatric TB cases in North Carolina between 1994 and 2002 — an incidence rate 15 times greater than for white children.

The study was presented May 23, 2004, at the American Thoracic Society meeting in Orlando, Fla. The study was a joint project between the Duke School of Medicine and North Carolina's TB Control Program. Funding was provided by Duke University Medical Center and the state of North Carolina.

"In general, incidence rates have improved over time, but we still have a way to go," said Carol Dukes Hamilton, M.D., an infectious diseases specialist and associate professor of medicine at Duke University Medical Center. Hamilton is medical director of North Carolina's Tuberculosis Control Program.

"Even though we are seeing more Hispanic children with the disease, African-Americans are still being disproportionately affected," she said. Socioeconomic factors, including access to health care and crowded living quarters, influence the disease rate in minority populations, Hamilton said.

Of the 180 children found to have TB disease between 1994 and 2002, 88 percent were non-white or white Hispanic. Non-Hispanic black children accounted for 63 percent of TB cases and Hispanic children for 18 percent of cases. The incidence rates were 3 per 100,000 population for African-American children; 4.5 per 100,000 population for Hispanic children; and 0.2 per 100,000 population for white children. There were 17 pediatric TB cases in North Carolina in 2003, a decline from a spike of 32 cases in 2002. There were nine cases in 2001.

The key to preventing tuberculosis in children is educating adults to recognize TB symptoms and quickly seek treatment, Hamilton said. When identified, the source of infection in the pediatric cases was always an adult, and most were found to be a parent, guardian or close relative. In 2002, two clusters of tuberculosis infections in young children occurred when women caring for children in their home exposed their charges to TB. Both adults had been coughing with tuberculosis for four months, Hamilton said.

"More than 25 percent of all the childhood cases could have been prevented if either the adults or children had taken preventive therapy when first found to have a reactive tuberculin skin test," Hamilton said.

Children younger than 5 years of age are most vulnerable to tuberculosis. "Children infected with TB are more likely than adults to progress to active disease and are more likely than adults to develop severe TB disease," said Kapil Saharia, a fourth-year Duke medical student and lead author of the study. The infection spreads throughout the body in young children, including the brain, instead of developing mainly in the lungs. Two children died of meningeal tuberculosis in North Carolina between 1994 and 2002.

Infants with tuberculosis may not develop a cough but will have fever, poor appetite and a failure to gain weight as expected. Symptoms in older children and adults include a cough that lasts for more than two weeks, fever, breaking out in a sweat at night, poor appetite and fatigue.

Tuberculosis can be cured with prompt medical treatment. Taking one pill of isoniazid each day for nine months can prevent infection in people who have no symptoms but have been exposed to tuberculosis.

Local health departments in North Carolina provide TB evaluation and treatment services free of charge. They do not require residency documents and do not report cases to U.S. Citizenship and Immigration Services.

Co-authors of the study include Jason Stout, M.D., an associate in Duke University Medical Center's department of medicine, and Amina Ahmed, M.D., a pediatric infectious diseases specialist at Carolinas Medical Center in Charlotte, N.C.

For more information, or to contact Duke University Medical Center, see their website at: www.mc.duke.edu