Missed opportunities for preventing tuberculosis among children younger than five years of age

Objectives. Childhood tuberculosis (TB) is an important indicator of public health success in interrupting and preventing TB transmission. To determin e the frequency and types of missed opportunities for preventing TB among c hildren <5 years of age. Methods. We collected data from the public health records of child TB cases and their adult source cases. These children were from health jurisdiction s where TB case rates in children were higher than the California average f or this age group. Results. We reviewed the records for 165 children reported with TB (20% con firmed by culture). These children were evaluated for TB because of signs o r symptoms of illness (32%), a contact investigation (26%), screening (22%) , a source case investigation (4%), and unknown reasons (16%). Excluding 4 children infected by Mycobacterium bovis, only 59 of 161 children (37%) had a source case found. Children found in a contact investigation, born in th e United States, <1 year of age, or who were black were more likely to have a source case found than children who did not have one of these characteri stics. Of 43 children found in a contact investigation, improvements in con tact investigations may have prevented TB in 17 of these children (40%). Am ong the 43 adult source cases, factors that may have facilitated transmissi on include delayed reporting in 23%, a delayed contact investigation in 21% , and delayed or nondocumented bacteriologic sputum conversion in 42% of cu lture-positive cases. Conclusions. Important missed opportunities to prevent TB in children inclu de the failure to find and appropriately manage adult source cases and fail ure to completely evaluate and properly treat children exposed to TB. Impro vements in case detection, case management, and contact investigations are necessary to eliminate TB in children.