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Prospective data on childhood tuberculosis (TB) incidence and case detection rates (CDRs) are scant, and the preventable burden of childhood TB has not been measured in prospective studies. We investigated 2,042 children (<15 years of age) with suspected TB by using enhanced surveillance and linked hospital, demographic, notification, and verbal autopsy data to estimate the incidence, CDR, risk factors, and preventable burden of TB among children in Kenya. Estimated TB incidence was 53 cases/100,000 children/year locally and 95 cases/100,000 children/year nationally. The estimated CDR was 0.20-0.35. Among children <5 years of age, 49% of cases were attributable to a known household contact with TB. This study provides much needed empiric data on TB CDRs in children to inform national and global incidence estimates. Moreover, our findings indicate that nearly half of TB cases in young children might be prevented by implementing existing guidelines for TB contact tracing and chemoprophylaxis. [ABSTRACT FROM AUTHOR]

Summary: Tuberculosis continues to cause an unacceptably high toll of disease and death among children worldwide, particularly in the wake of the HIV epidemic. Increased international travel and immigration have led to a rise in childhood tuberculosis rates even in traditionally low burden, industrialised settings, and threaten to promote the emergence and spread of multidrug-resistant strains. Whereas intense scientific and clinical research efforts into novel diagnostic, therapeutic, and preventive interventions have focused on tuberculosis in adults, childhood tuberculosis has been relatively neglected. However, children are particularly vulnerable to severe disease and death following infection, and those with latent infection become the reservoir for future transmission following disease reactivation in adulthood, fuelling future epidemics. Further research into the epidemiology, immune mechanisms, diagnosis, treatment, and prevention of childhood tuberculosis is urgently needed. Advances in our understanding of tuberculosis in children would provide insights and opportunities to enhance efforts to control this disease. [Copyright &y& Elsevier]

Summary: Despite significant improvements in tuberculosis (TB) management under the WHO directly observed treatment, short course (DOTS) strategy, childhood TB has been relatively neglected. Children are at high risk of severe disease, and reactivation of latent infection in adulthood perpetuates the epidemic. Almost a million cases of childhood TB are estimated to occur annually, but good-quality epidemiological data are scarce due to inherent difficulties diagnosing paediatric TB. There remains an urgent need both for better diagnostic tests and for robust regional data on the true burden of disease, otherwise childhood TB will remain an essentially ‘invisible’ and therefore neglected disease. [Copyright &y& Elsevier]