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Two infants born 4 days apart, and cared for in the same nursery, developed miliary tuberculosis at 2.5 and 5.5 months of age, respectively. A search for a source case among household contacts failed to reveal anyone with active tuberculosis. An epidemiologic study of nursery personnel revealed a nurse's aide with cavitary tuberculosis. Examination of 1,647 infants (98.9 per cent of all infants cared for in the nursery during the 10.5-month period preceding the discovery of the source case) failed to reveal any other infected children. Recommendations are made for tuberculosis control programs among nursery personnel that should be carefully and persistently followed.

A continuing study of the frequency of primary drug resistance among children treated at the Kings County Hospital Center of Brooklyn during the years 1973 through 1977 showed a high incidence of primary drug resistance to isoniazid (8.8 per cent) and to streptomycin (12.3 per cent). In contrast, there were no strains resistant to cycloserine, viomycin, ethambutol, or rifampin, and only one of 57 strains (1.8 per cent) was resistant to ethionamide, and one (1.8 per cent) was resistant to para-aminosalicylic acid. Comparison with previous studies begun in 1961 showed no significant increase in resistance to isoniazid during 3 prior periods of study and no increase in resistance to streptomycin during the last 2 periods of study. It must be emphasized that these findings relate only to the children of a local community, and do not reflect the prevalence of primary drug resistance elsewhere in this country or among different age groups.

A 20-yr prospective study of the incidence of primary drug-resistant tuberculosis among children treated at the Kings County Medical Center was undertaken in January 1961 and extended through December 1980. There were 355 strains of Mycobacterium tuberculosis isolated during this time, 56 of which were found to be primarily resistant to one or more antituberculosis drugs, giving an overall resistance rate of 15.8%. The study was divided into five 4-yr periods. The resistance rate to isoniazid was 9.9%, varying from a peak of 15.2% in the third period of study (1969 to 1972) to 4.5% in the last period of study. The changes in the rate were not significant. The overall resistance rate for streptomycin was 9.2%. There were significant increases in the resistance rate in the second (1965 to 1968) and third (1969 to 1972) periods of study, but not in the last 2 periods. The rates for PAS (3.4%), rifampin (1%), and ethambutol (0.7%) were low. The type and severity of disease among those infected with a resistant strain were no different from those infected with a susceptible strain. Life-threatening disease was found in 10 of the 56 patients infected with a drug-resistant strain. There was one fatality in a child with meningitis who was treated early in the study. Our experience suggests that rifampin and ethambutol be included in the initial treatment regimen of all children with a life-threatening form of tuberculosis until the susceptibility pattern of the infecting strain is determined, after which the drug regimen can be modified if necessary.

A prospective study of primary drug-resistant strains of Mycobacterium tuberculosis among children was begun at the Kings County Hospital Medical Center of Brooklyn in 1961 and reported at 5 4-yr periods through 1980. The present report extends our observations of primary drug-resistant tuberculosis in children through 1984. The salient finding in the present report was the increase in primary drug resistance to rifampin, 3 of 19 strains resistant in the last period of study (1981 to 1984) as compared with 1 of 96 strains isolated in the previous 3 periods of study (1969 to 1980). This increase was significant (p less than 0.02) even though the number of strains isolated was small. There were continued low resistance rates to ethambutol and para-aminosalicylic acid and stable resistance rates for isoniazid and streptomycin.