In 2018, 9,025 cases of tuberculosis were reported in the United States, the lowest number on record. While cases in the US are on the decline and incidence rates among children and adolescents fell by 48% between 2007 and 2017, lapses in testing guidelines undermine efforts to completely eliminate tuberculosis in the country.
The current guidelines recommend testing individuals identified through contact tracing (persons exposed to those with diagnosed illness), as well as those who were born or have travelled outside the US for at least two months. As depicted in the graph above, only two-thirds of children with tuberculosis in the US from 2010 to 2017 would have been recommended for tuberculosis testing—38% through contact tracing, 21% due to being born outside the US, and 8% due to travel outside the US for at least two months.
The remaining one-third of children, particularly those born in the US to at least one parent born abroad, did not meet the guidelines for testing. Given this reality, guidelines that identify determinants beyond origin of birth or travel are necessary. Ending tuberculosis in the US will require a comprehensive approach that entails vigilant surveillance, education of healthcare providers, and increased efforts to identify and treat the disease in high-risk populations.
Databyte via Cowger, Tori L, et al. “Epidemiology of Tuberculosis among Children and Adolescents in the USA, 2007–17: an Analysis of National Surveillance Data.” The Lancet Public Health, vol. 4, no. 10, 2019.