The epidemiology of tuberculosis in children

The analysis of the data on tuberculosis in children, young adults and the entire population in the Netherlands for the last 75 years clearly indicates that the increase in tuberculosis incidence from the late 1980s onwards was nearly exclusively due to the 'imported' tuberculosis from high prevalence countries. This is demonstrated in figure 2 and table in: 61% of cases in children, 75% in young adults aged 15-24 years and 56% of all 1,497 cases notified in 1994 were diagnosed among foreigners. It is demonstrated that tuberculosis rates among the Dutch population continued to decrease gradually during the last two decades, from 14.4/100,000 in 1975 to 4.5/100,000 in 1994. It is obvious that the 'imported' tuberculosis was virtually responsible for the distinct increase of tuberculosis cases in the last two decades, although HIV infection and tuberculosis in certain high risk groups may have also influenced the rates. There is no doubt that tuberculosis incidence will continue to decrease in Dutch children and could fall to around 1/100.000 at the turn of the century. The main problem remains an early diagnosis of a very low number of severe tuberculosis cases in children. It is therefore of great importance to control tuberculosis among foreigners for at least a further two decades, since their current rates are 10 to 20 times higher than those among the Dutch population. It should be stressed that an increased incidence of tuberculosis in the last decade in the Netherlands had only a relatively slight impact on the transmission of infection because most infectious cases were diagnosed early and effectively cured.