Childhood tuberculosis in the 1990s.

Tuberculous infection and disease rates among children in the United States are rising, but they also are being confined mostly to well-defined groups of high-risk children. Most children are at very low risk for infection, and routine screening of these large numbers of low-risk children is not necessary. Clinicians who care for children need to stratify their patients by risk for tuberculosis, and provide periodic testing for those truly at risk. Public health efforts need to concentrate on identifying and completing treatment of adults with infectious tuberculosis who are the sources of infection for high-risk children. We need to use the best tools available, and use them wisely.