Racial and Ethnic Disparities in Pediatric Tuberculosis in North Carolina

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.