But that good news doesn't apply to everyone. The incidence of the
disease among certain racial and ethnic groups was at least 14 times
higher than among non-Hispanic white children and adolescents,
researchers report in The Lancet Public Health.
"There are effective interventions to prevent children and
adolescents from developing TB, such as finding, evaluating and
treating those who have been in close contact with someone who has
TB disease, and providing TB testing for those at high risk for TB
infection or disease," said the study's lead author, Tori Cowger, a
Ph.D. student in population health sciences at Harvard's T.H. Chan
School of Public Health in Boston.
"To address the disproportionately high TB incidence rates that we
observed among some socioeconomic groups of children and
adolescents, it will be important to implement these proven
interventions, and possibly to consider new approaches to reduce the
disparities in TB incidence and mortality in these age groups,"
Cowger said in an email.
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Cowger and colleagues from Harvard and the U.S. Centers for Disease
Control and Prevention analyzed data from the U.S. National
Tuberculosis Surveillance System (NTSS) collected from 2007 to 2017.
During that period, 6,072 cases of tuberculosis were reported to the
NTSS - 5,175 in U.S states and 897 in U.S. affiliated Islands.
Among the children and adolescents with tuberculosis in U.S. states,
3,520 had been born in the U.S., of whom nearly half were Hispanic.
Among those born elsewhere, the majority were Asian or black.
Under current targeted screening guidelines, about two-thirds of the
children younger than 15 would have been recommended for testing.
Among the remaining children of that age, 21% had at least one
parent born abroad.
Rates among Native Hawaiian and Pacific Islander children and
adolescents were more than 3 times as high as any other racial or
ethnic group and 114 times higher than non-Hispanic white children
and adolescents.
Rates among all other single race or ethnicity groups were at least
14 times higher than rates among non-Hispanic white children and
adolescents. The incidence among children born outside the U.S. was
12.9 times higher than among those born in the U.S. The highest
rates were among children born in Africa or Oceania.
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Overall, tuberculosis rates among children and adolescents declined
47.8% during the decade studied.
Rates of TB decreased among all racial and ethnic groups except for
Native Americans, Alaska Natives, Native Hawaiians, Pacific
Islanders and children and adolescents of 2 or more races.
The new findings will help researchers understand the trends and
status of the TB epidemic, said Dr. Nicole Salazar-Austin, an
assistant professor at the Johns Hopkins School of Medicine in
Baltimore. "The nice thing the study shows is that tuberculosis
incidence among children and adolescents in the U.S. continues to
dramatically decrease."
But "the burden of the disease persists among vulnerable populations
that are best defined by race and ethnicity," Salazar-Austin said.
"It's important to identify those who are most affected so we can
target future programs and preventive services to those populations
in particular."
One clear example of a group that might be targeted for tuberculosis
screening based on the new study is children born in the U.S., who
have a parent born outside the U.S., Salazar-Austin said.
The populations found to be most at risk for TB aren't surprising,
Salazar-Austin said. "If you look at the history of tuberculosis,
the poor and vulnerable populations have always been the most
affected."
There are several reasons for that, Salazar-Austin said. "Part of it
is access to care," she said. "Part is health education. And part is
related to the fact that small, enclosed, crowded spaces with poor
ventilation facilitate tuberculosis transmission. And that often
describes the living conditions of any society's poor and vulnerable
populations."
SOURCE: http://bit.ly/2MTaP7N and http://bit.ly/2MR7u9w Lancet
Public Health, online August 21, 2019.
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