Tuberculosis in Children Fact Sheet

February 2010

Cases of active or latent tuberculosis infection in children are of great concern since it indicates that transmission of tuberculosis has occurred recently.1 Most adults who develop active tuberculosis were infected many years ago, when their immune systems were stronger and able to protect them. When a child is diagnosed with active tuberculosis, it means that someone close to them, almost always an adult, must have active tuberculosis and is possibly transmitting the disease to others as well.

  • In 2008, in the United States 786 children 14 and younger had TB, a case rate of 1.3 per 100,000. Between 1993 and 2008 the tuberculosis cases rate among children 14 and younger decreased 55.2 percent.2
  • The World Health Organization states over 250,000 children develop and 100,000 die from TB each year.3
  • In 2008, California and Texas accounted for over 30 percent of new TB cases in children 14 and younger.4
  • In 2008, Hispanic and non-Hispanic black children 14 years or younger accounted for almost three quarters (74%) of TB cases in that age group.5
  • Native Hawaiians and other Pacific Islanders had the highest TB case rate in children under 5 years of age (8.4 per 100,000), followed by Asians (8.3 per 100,000), American Indians or Alaska Natives (4.7 per 100,00),non-Hispanic Blacks (4.6 per 100,000), Hispanics (4.4 per 100,000), and non-Hispanic Whites (0.3 per 100,000).6
  • Diagnosis of tuberculosis in children is difficult and poses problems that are not present in adults. Children are less likely to have obvious symptoms of tuberculosis. In addition, sputum samples are difficult to collect from children. Some doctors and clinics may now use newer blood tests instead of the skin test. Culture and drug susceptibility results from tests of the adult source case often have to be relied upon for diagnosing and properly treating tuberculosis in a child.7
  • Tuberculosis in infants and children younger than four years of age is much more likely to spread throughout the body through the bloodstream. Because of this, children are at much greater risk of developing tuberculosis meningitis, a very dangerous form of the disease that affects the central nervous system. For these reasons, prompt diagnosis and immediate treatment of tuberculosis are critical in pediatric cases.8
  • Some groups of children are at greater risk for tuberculosis than others. These include:
    • children living in a household with an adult who has active tuberculosis
    • children living in a household with an adult who is at high risk for contracting TB i.e. HIV infection, medically underserved, low-income, and foreign-born persons recently arrived (within 5 years) from countries that have a high TB incidence or prevalence
    • children infected with HIV or another immunocompromising condition
    • children born in a country that has a high prevalence of tuberculosis
    • children from communities that are medically underserved
  • In general, the same methods are used in treating tuberculosis in children as are used in treating tuberculosis in adults. The primary difference between treatment for adults and children is the use of ethambutol. One of the side effects of ethambutol is impaired vision. Because this effect is difficult to monitor in young children, ethambutol is not routinely recommended for children less then five years old.9
  • Direct Observed Therapy (DOT) is a system of treatment in which the patient is administered his or her medication by a nurse or health worker and is observed taking the medication. DOT should be used with all children with tuberculosis. The lack of pediatric dosage forms of most anti-tuberculosis medications necessitates using crushed pills and suspensions. Even when drugs are given under DOT, tolerance of the medications must be monitored closely.10 In 1999, 82.9 percent of children received DOT for part of their treatment and 94.8 percent completed treatment.11
  • The best method to prevent cases of pediatric tuberculosis is to find, diagnose, and treat cases of active tuberculosis among adults. Children do not usually contract tuberculosis from other children or transmit it themselves. Adults are usually the ones who pass tuberculosis on to children. Improved contact investigations and use of directly observed therapy should increase the success rate of finding and treating adult cases of tuberculosis, therefore reducing the number of cases of pediatric tuberculosis.
  • Recently, there has been increased awareness of outbreaks of an almost eradicated form of TB, infection with M. Bovis, among regions with large Hispanic populations. M. Bovis is spread by consuming raw dairy products or inhaling droplets from infectious cattle. A recent study in San Diego found an increasing trend of M. Bovis over the preceding decade, that almost all cases in 2001-2005 were in persons of Hispanic ethnicity, and that 45% of cases in children under 15 years of age were caused by M Bovis.12

For more information on tuberculosis, please review the Tuberculosis Morbidity and Mortality Trend Report in the Data and Statistics section of our website at www.lung.org or call the American Lung Association at 1-800-LUNG-USA (1-800-586-4872).

1. American Thoracic Society, CDC and Infectious Disease Society of America. Treatment of Tuberculosis. Morbidity and Mortality Weekly Report. June 20, 2003; 52(RR-11).

2. Centers for Disease Control and Prevention. Department of Health and Human Services. Reported Tuberculosis in the United States, 2008. September 2009.

3. World Health Organization. Communicable Diseases: TB and Children Fact Sheet. April 2006. Available at http://www.searo.who.int/en/Section10/Section2097/Section2106_10681.htm. Accessed February 12, 2010.

4. Centers for Disease Control and Prevention. Department of Health and Human Services. Reported Tuberculosis in the United States, 2008 September 2009.

5. Ibid.

6. Ibid.

7. American Thoracic Society, CDC and Infectious Disease Society of America. Treatment of Tuberculosis. Morbidity and Mortality Weekly Report. June 20, 2003; 52(RR-11).

8. Ibid.

9. Ibid.

10. Ibid.

11. Nelson LJ, Schneider E, Wells CD, and Moore M. Epidemiology of Childhood Tuberculosis in the United States 1993-2001: The Need for Continued Vigilance. Pediatrics. August 2004; 114: 333-341.

12. Rodwell TC, Moore M, Moser KS, Brodine SK, Strathdee SA. Tuberculosis from Mycobacterium bovis in Binational Communities, United States. Emerging