EPIDEMIOLOGY OF PEDIATRIC TUBERCULOSIS IN CHICAGO, 1974 TO 1994 - A CONTINUING PUBLIC-HEALTH PROBLEM

Despite downward trends in the overall rate of tuberculosis in the Uni ted States for 1993 to 1994, the rate among children (0 to 14 years) h as increased. To evaluate the trend in pediatric tuberculosis in Chica go and better direct public health efforts to control tuberculosis, we analyzed summary data for 1974 to 1981 and detailed data for 1982 to 1994 from surveillance case reports. These data were compared to the 1 980 and 1990 census data for the 77 community areas in Chicago. Of the 18,700 cases of tuberculosis reported in Chicago for the study period , 702 (3.8%) occurred in children. Children accounted for a significan tly increasing proportion of reported cases, 204/7093 (2.9%) in 1974 t o 1981 versus 498/11,607 (4.3%) in 1982 to 1994, a trend which began i n 1982. The number of cases among immigrants remained low throughout t he study. Sites of infection were as follows: 73% pulmonary parenchyma l disease, 9% hilar adenopathy, 9% extrathoracic lymph adenopathy, 3% meningitis, 3% miliary, and 3% other. From 1982 to 1994, 13 communitie s had a total of 224 cases (45%); average rates were > 10/100,000 in t he population under 15 years old, and 7 of these communities had 127 c ases (25%); average rates were > 15/100,000. Of the 77 community areas , 16 (21%) had no pediatric tuberculosis. Comparison of case rates wit h socioeconomic and health indicators showed the highest rates in comm unities with multiple indicators of poverty, including overcrowded hou sing units, low median income, and high infant mortality rates. Pediat ric tuberculosis in Chicago remains a significant public health proble m. Efforts to address this problem should provide resources to the com munity areas with the highest incidence rates.