Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2005 Nov;90(11):1157–1161. doi: 10.1136/adc.2004.066415

Tuberculosis in New Zealand, 1992–2001: a resurgence

S Howie 1, L Voss 1, M Baker 1, L Calder 1, K Grimwood 1, C Byrnes 1
PMCID: PMC1720148  PMID: 16243871

Abstract

Objective: To describe the recent epidemiology and clinical features of paediatric tuberculosis (TB) in New Zealand (NZ).

Methods: A retrospective review was conducted of clinical, laboratory, and radiology records of children <16 years old diagnosed with TB between January 1992 and June 2001 in nine NZ health districts.

Results: A total of 274 patients <16 years old were identified; the average annual TB rate was 4.8 per 100 000. Rates rose over time reaching a peak of 10.1 in 1999. Rates were highest in under-5 year olds, at 6.2 per 100 000, and varied by ethnicity: African 575.2, Pacific Island 15.2, Maori 6.4, Asian 5.6, and European 0.6. Seventy two cases (26%) were foreign born. Thirty six per cent of cases were not detected until they presented with symptoms and of these 44% had no known TB contact. Most cases were identified by contact tracing (48%) or immigrant screening (11%); 43% were part of outbreaks. Miliary TB or meningitis occurred in 8% of patients, two of whom died. Drug resistance was found in 7% of culture positive cases and no HIV co-infection was found.

Conclusions: A resurgence of TB occurred among children in NZ between 1992 and 2001 predominantly involving non-European and immigrant groups. Despite established contact tracing and immigrant screening programmes, many cases were part of outbreaks, remained unidentified until symptoms arose, or had no known TB contact. These findings point to an unrecognised burden of adult disease, ongoing community transmission, and missed opportunities for prevention. Further study is required to confirm these hypotheses.

Full Text

The Full Text of this article is available as a PDF (80.7 KB).

Figure 1.

Figure 1

Open in a new tab

 Annual tuberculosis incidence rates in New Zealand children below 16 years of age between 1992 and 2001. *Absolute numbers of cases; †2001 included January 1st to June 30th only.

Figure 2.

Figure 2

Open in a new tab

 Social deprivation in New Zealand TB cases <16 years of age 1992–2001 versus all NZ births 1992–2001 (data source: Birth Registration Dataset, NZ Health Information Service). *Decile 10, most deprived 10% of population.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balasegaram S., Watson J. M., Rose A. M. C., Charlett A., Nunn A. J., Rushdy A., Leese J., Ormerod L. P., Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group A decade of change: tuberculosis in England and Wales 1988-98. Arch Dis Child. 2003 Sep;88(9):772–777. doi: 10.1136/adc.88.9.772. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Berggren Palme I., Gudetta B., Bruchfeld J., Eriksson M., Giesecke J. Detection of Mycobacterium tuberculosis in gastric aspirate and sputum collected from Ethiopian HIV-positive and HIV-negative children in a mixed in- and outpatient setting. Acta Paediatr. 2004 Mar;93(3):311–315. doi: 10.1080/08035250410023566. [DOI] [PubMed] [Google Scholar]
  3. Burroughs M., Beitel A., Kawamura A., Revai K., Ricafort R., Chiu K., Jacobs R., Riley L. Clinical presentation of tuberculosis in culture-positive children. Pediatric Tuberculosis Consortium. Pediatr Infect Dis J. 1999 May;18(5):440–446. doi: 10.1097/00006454-199905000-00008. [DOI] [PubMed] [Google Scholar]
  4. Calder L., Hampton L., Prentice D., Reeve M., Vaughan A., Vaughan R., Harrison A., Voss L., Morris A. J., Singh H. A school and community outbreak of tuberculosis in Auckland. N Z Med J. 2000 Mar 10;113(1105):71–74. [PubMed] [Google Scholar]
  5. Chaulk C. P., Khoo L., Matuszak D. L., Israel E. Case characteristics and trends in pediatric tuberculosis, Maryland, 1986-1993. Public Health Rep. 1997 Mar-Apr;112(2):146–152. [PMC free article] [PubMed] [Google Scholar]
  6. Corbett Elizabeth L., Watt Catherine J., Walker Neff, Maher Dermot, Williams Brian G., Raviglione Mario C., Dye Christopher. The growing burden of tuberculosis: global trends and interactions with the HIV epidemic. Arch Intern Med. 2003 May 12;163(9):1009–1021. doi: 10.1001/archinte.163.9.1009. [DOI] [PubMed] [Google Scholar]
  7. Correa A. G. Unique aspects of tuberculosis in the pediatric population. Clin Chest Med. 1997 Mar;18(1):89–98. doi: 10.1016/s0272-5231(05)70358-0. [DOI] [PubMed] [Google Scholar]
  8. Driver C. R., Luallen J. J., Good W. E., Valway S. E., Frieden T. R., Onorato I. M. Tuberculosis in children younger than five years old: New York City. Pediatr Infect Dis J. 1995 Feb;14(2):112–117. doi: 10.1097/00006454-199502000-00006. [DOI] [PubMed] [Google Scholar]
  9. Dye C., Scheele S., Dolin P., Pathania V., Raviglione M. C. Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. JAMA. 1999 Aug 18;282(7):677–686. doi: 10.1001/jama.282.7.677. [DOI] [PubMed] [Google Scholar]
  10. Harrison A., Calder L., Karalus N., Martin P., Kennedy M., Wong C. Tuberculosis in immigrants and visitors. N Z Med J. 1999 Sep 24;112(1096):363–365. [PubMed] [Google Scholar]
  11. Martin P. Tuberculosis in New Zealand: why do we have twice as much as Australia? N Z Med J. 2000 Mar 10;113(1105):68–69. [PubMed] [Google Scholar]
  12. Milburn H. J., Gibilaro J., Atkinson H., Heathcock R. High incidence of primary tuberculosis. Arch Dis Child. 2000 May;82(5):386–387. doi: 10.1136/adc.82.5.386. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Nelson Lisa J., Schneider Eileen, Wells Charles D., Moore Marisa. Epidemiology of childhood tuberculosis in the United States, 1993-2001: the need for continued vigilance. Pediatrics. 2004 Aug;114(2):333–341. doi: 10.1542/peds.114.2.333. [DOI] [PubMed] [Google Scholar]
  14. Palme Ingel Berggren, Gudetta Berhanu, Bruchfeld Judith, Muhe Lulu, Giesecke Johan. Impact of human immunodeficiency virus 1 infection on clinical presentation, treatment outcome and survival in a cohort of Ethiopian children with tuberculosis. Pediatr Infect Dis J. 2002 Nov;21(11):1053–1061. doi: 10.1097/00006454-200211000-00016. [DOI] [PubMed] [Google Scholar]
  15. Parslow R., El-Shimy N. A., Cundall D. B., McKinney P. A. Tuberculosis, deprivation, and ethnicity in Leeds, UK, 1982-1997. Arch Dis Child. 2001 Feb;84(2):109–113. doi: 10.1136/adc.84.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Starke J. R., Jacobs R. F., Jereb J. Resurgence of tuberculosis in children. J Pediatr. 1992 Jun;120(6):839–855. doi: 10.1016/s0022-3476(05)81949-3. [DOI] [PubMed] [Google Scholar]
  17. Starke J. R., Taylor-Watts K. T. Tuberculosis in the pediatric population of Houston, Texas. Pediatrics. 1989 Jul;84(1):28–35. [PubMed] [Google Scholar]
  18. Vallejo J. G., Ong L. T., Starke J. R. Clinical features, diagnosis, and treatment of tuberculosis in infants. Pediatrics. 1994 Jul;94(1):1–7. [PubMed] [Google Scholar]
  19. Walls Tony, Shingadia Delane. Global epidemiology of paediatric tuberculosis. J Infect. 2004 Jan;48(1):13–22. doi: 10.1016/s0163-4453(03)00121-x. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES