Tuberculosis (TB) in childhood
This study ran from December 2003 to January 2005. At that time, in the UK, tuberculosis (TB) notification rates had stabilised at 11-12 /100,000 population. However, notification rates in London over the decade before the study were more than three times this level. National data on paediatric TB could be derived from statutory notifications and, since 1999, via the enhanced surveillance system. This BPSU study was important in both validating the enhanced surveillance system and informing the development of services for children with TB as part of the overall infection strategy for children.
Lead investigator
Dr D Shingadia
About the study
This study ran from December 2003 to January 2005. At that time, in the UK, tuberculosis (TB) notification rates had stabilised at 11-12 /100,000 population. However, notification rates in London over the decade before the study were more than three times this level.
Immigration from high-prevalence countries and an increase in HIV infection were cited as possible factors leading to the resurgence in TB cases in some areas of the UK. In particular, notifications of TB in children had increased at a rate greater than the overall TB notification rate, most critically in London, where there has been a 130% increase. Cases of childhood TB were important from a public health viewpoint. Not only did they form a reservoir of potential future cases, but they were also sentinel events reflecting recent transmission from an infected adult who also would be a risk to others.
National data on paediatric TB could be derived from statutory notifications and, since 1999, via the enhanced surveillance system. Mycobnet provided additional data. This system monitored anti-TB drug resistance in the UK, as well as information on TB species and demographic data. However, the accuracy of these parallel reporting systems in determining the true incidence of childhood TB in the UK was uncertain.
There was no validation of the completeness and accuracy of the enhanced surveillance system, and it had been suggested that both under- and over-notification of cases of childhood TB occurred. There was also a lack of data on the clinical spectrum of childhood TB in the UK. Although pulmonary TB was the most common form of childhood TB disease, there had been an increasing number of children with TB central nervous system disease in London who represented an unusually high proportion of all childhood TB cases.
The Chief Medical Officer for England had published a strategy for health protection entitled Getting Ahead of the Curve. In this strategy, TB was identified as a key infectious disease problem necessitating intensified control measures, including surveillance to reduce illness and death. A TB Action Plan, Stopping TB in England, was published in 2004. This plan highlighted the need for high-quality surveillance at local, national and international levels.
In addition, a children’s National Service Framework (NSF) had been proposed to develop networks of care for children. It had been proposed that the NSF include an infection strategy which prioritised preventative and clinical services for children with infections.
This BPSU study would be important in both validating the enhanced surveillance system and informing the development of services for children with TB as part of the overall infection strategy for children.
Duration
December 2003 – January 2005
Published papers
Support group