Global epidemiology of childhood tuberculosis.

Tuberculosis (TB) in children has been less of a public health priority in recent years, despite the fact that TB is an important cause of childhood morbidity and mortality worldwide. Data on trends in childhood TB are scarce in the published literature. The diagnosis of TB in children is difficult, and rarely rests on bacteriologic confirmation. Surveillance data for children in many countries are lacking and there are few epidemiologic studies. However, in regions of the world such as sub-Saharan Africa where adult TB is increasing, this trend is likely occurring among children as well. This review documents an increase in childhood TB in many parts of the world. Risk factors vary by region. Improvements in global surveillance of childhood TB, investigation of the role of national TB programs (NTPs) in improving the control of childhood TB, and better identification of risk factors for childhood disease will be crucial to future control efforts for childhood TB. This might include assessment of optimal methods of contact investigations and an analysis of NTP data to assess risk factors for adverse outcomes (e.g., death, default, treatment failure) among children. Ultimately, these data will ensure the success of interventions to reduce the burden of childhood TB using strategies that specifically target this population. As children represent the future burden of TB disease, these efforts could significantly reduce the overall global burden of TB in years to come.