Tuberculosis: 5. Pediatric disease.

Between 1980 and 1995, the total number of active cases of tuberculosis (TB) in Canada declined steadily, from 2762 to 1930; the corresponding rates per 100 000 population were 11.2 and 6.5. During the same period, the number of cases of primary TB among children younger than 15 years remained disturbingly similar: 145 cases in 1980 and 156 in 1995. The rates were higher for those under 4 years of age than for those 5–14 years of age (Table 1). In 1995, 99 of 176 cases of pediatric TB occurred in aboriginal children. Over the 10-year period 1985 to 1994, the number of cases of pediatric TB reported in the United States increased by 33%. The occurrence of TB in children implies recent transmission in the community and reflects the effectiveness of TB control programs. A history of the disease in the household, foreign birthplace and poor socioeconomic circumstances, such as in the inner city, are the main risk factors. Around the world, almost 500 children die of TB each day, and it has been estimated that 170 000 children die each year from the 2 most severe forms of disseminated disease, meningeal and miliary TB.