A Population-based Study of Tuberculosis in Children and Adolescents in Ontario

Background: There are few population-based data on presentation and treatment of tuberculosis (TB) in children and adolescents in Ontario.

Methods: We analyzed data from 121 patients less than 17 years of age with TB disease reported to the Province of Ontario between 1999 and 2002. Physician provider data were obtained from the College of Physicians and Surgeons of Ontario.

Results: Of the 121 patients, 84 (69.4%) patients were foreign born. The median time of residence in Canada before diagnosis was 2.7 years (range, 7 days-16 years). Diagnosis was made by symptoms in 78 (64.5%), by contact investigation in 25 (20.7%), and by immigration screening in 5 (4.1%) patients. Pulmonary TB occurred in 94 (77.7%) patients. When cases detected by contact tracing and screening were excluded, isolated extrapulmonary TB was present in 4 (23.5%), 6 (35.0%), and 19 (37.0%) of young children (0-4 years), older children (5-12 years), and adolescents (13-17 years), respectively. Eleven patients (9.1%) had drug-resistant strains. Eighty (66.1%) patients received directly observed therapy (DOT). Prescribed treatment was completed in 105 (86.8%) patients with a trend toward higher completion rates in those receiving DOT (P = 0.07). Of 57 physician providers, 50 (87.7%) had treated less than 1 pediatric TB patient/year during the study period.

Conclusions: Extrapulmonary disease accounted for a high proportion of TB in older children and adolescents who presented with symptoms. One-third of patients did not receive DOT and most were cared for by physicians with limited experience in managing TB. Further studies are needed to determine whether these factors influence outcome in pediatric TB.