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An evaluation of the completeness of reporting of childhood tuberculosis

¹ Centre for Child Health, University of London, ⁴ Respiratory Diseases Dept, Health Protection Agency, Centre for Infections, ⁶ Centre for Sexual Health and HIV Research, ⁸ Centre for Infectious Disease Epidemiology, University College London, ¹⁰ Dept of Respiratory Medicine, St Bartholomew's Hospital and Royal London Hospital, ¹¹ Dept of Infectious Diseases, Great Ormond Street Hospital, ⁹ Paediatric Infectious Diseases Unit, St George's Hospital, London, ² Dept of Child Health, Llandough Hospital, ³ Communicable Disease Surveillance Centre, National Public Health Service for Wales, Cardiff, ⁵ Royal Liverpool Children's Hospital (Alder Hey), Liverpool, and ⁷ Dept of Paediatrics, Newcastle General Hospital, Newcastle, UK.

CORRESPONDENCE: D. Shingadia, Dept of Infectious Diseases, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, United Kingdom. E-mail: shingd{at}gosh.nhs.uk

Keywords: Child, disease notification, medical record linkage, population surveillance, tuberculosis

Received: February 29, 2008
Accepted February 4, 2009

The sensitivity of the Enhanced Tuberculosis Surveillance (ETS) scheme for monitoring tuberculosis in children is unknown.

We used the British Paediatric Surveillance Unit (BPSU) reporting scheme to conduct a prospective observational study of tuberculosis in children aged <16 yrs in the UK. Reported cases were then matched with records from the ETS database.

A total of 320 cases were reported to the BPSU between January and December 2004. We estimated that there were 557 paediatric cases in England, Wales and Northern Ireland in 2004: 222 (40%) cases reported to both BPSU and ETS, 98 (18%) reported to BPSU but not ETS and 237 (42%) reported to ETS but not BPSU. Children aged <5 yrs were significantly less likely to be reported to ETS compared with older children (p<0.01).

There is substantial under-reporting of childhood tuberculosis, especially of children aged <5 yrs. ETS provides a representative picture of the demographics but may miss 20% of cases. This should be taken into account when planning training and resource requirements for tuberculosis. Increased efforts are needed to ensure that all paediatric cases are reported to ETS.