Despite the availability of effective antituberculosis drugs, tuberculosis remains an important cause of morbidity, mortality, and healthcare expenditures in the United States. It is estimated that more than 10 million people in the United States are infected with the tubercle bacillus. More than 26 000 new cases of clinical tuberculosis occur every year, 1600 of which occur in children. Factors that serve to sustain tuberculosis in the United States include infection with the human immunodeficiency virus (HIV), influx of foreign-born individuals at increased risk of developing tuberculosis, and poverty and poor access to medical care experienced by large segments of the population.
The Centers for Disease Control (CDC) has a goal of eliminating tuberculosis from the United States by the year 2010. If this goal is to be achieved, programs must focus on children because they are the future reservoir for the disease. Tuberculosis cases in children are important public health markers for a community insofar as they represent ongoing transmission of the disease and at least a partial failure of current tuberculosis control efforts.
Epidemiology of Childhood Tuberculosis
The incidence of tuberculosis in the United States declined steadily for a 25-y period until 1985, when it leveled off (Fig 1). More than 26 000 cases of tuberculosis were diagnosed in the United States during 1991; almost 1600 cases occurred in children <15 y.