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Increased Reported Cases of Tuberculosis Among Children Younger Than 5 Years of Age, Maricopa County, Arizona, 2002–2003

Objectives: Although tuberculosis (TB) rates in the United States among children younger than 5 years old (2.8/100,000 in 2003) have been declining, Maricopa County, Arizona, reported an increase from 4.1/100,000 in 2002 to 9.0/100,000 in 2003. We investigated factors associated with this increase. Methods: We reviewed county TB clinic records of pediatric patients (younger than 5 years old) and their probable adult sources, interviewed parents or guardians of pediatric TB patients and examined changes in clinic procedures. Results: We verified 11 pediatric TB cases in 2002 and 25 in 2003 (n = 36). A total of 31 (86%) patients were born in the United States, and 28 (78%) had at least 1 foreign-born parent. There were 19 children (53%) identified from an adult TB contact investigation. Of children with identified sources (n = 24, 67%), 23 (96%) had probable household transmission; 20 (83%) had a foreign-born relative from a TB-endemic country as the probable source. Seven (50%) of 14 adult sources investigated had a delayed TB diagnosis. In 2003, increased TB clinic staffing, more frequent pediatric TB clinics and on-site gastric aspirates for TB diagnosis contributed to 55% more children being evaluated for TB. Conclusions: Close interaction with family members and delayed diagnoses were the primary means of TB transmission to children. The increase in pediatric TB likely reflects improved clinic diagnostic capacity and may indicate a more accurate baseline rate for Maricopa County. Programmatic improvements in TB control and targeted outreach to high-risk immigrant populations may increase pediatric and adult source case detection and reduce Mycobacterium tuberculosis transmission.