Abstract
Background Tuberculosis (TB) in children and adolescents is a sentinel event for ongoing transmission. In the Netherlands, epidemiological characteristics of childhood and adolescent TB have not been fully evaluated. Therefore, we aimed to assess TB epidemiology within this population to provide guidance for TB elimination.
Methods A retrospective time-series analysis using national surveillance data from 1993–2018 was performed in children (aged <15 years) and adolescents (aged 15–19 years) with TB. Poisson regression models offset with log-population size were used to estimate notification rates and rate ratios. Trends in notification rates were estimated using average annual percentage changes (AAPC) based on the segmented linear regression analysis.
Results Among 3899 children and adolescents with TB notified during 1993–2018, 2418 (62%) were foreign-born (725 (41.3%) out of 1755 children and 1693 (78.9%) out of 2144 adolescents). The overall notification rate in children was 2.3 per 100 000 person-years, declining steadily during the study period (AAPC −10.9%, 95% CI −12.6–−9.1). In adolescents, the overall notification rate was 8.4 per 100 000 person-years, strongly increasing during 1993–2001 and 2012–2018. Compared to Dutch-born children and adolescents, substantially higher notification rates were observed among African-born children and adolescents (116.8 and 316.6 per 100 000 person-years, respectively). Additionally, an increasing trend was observed in African-born adolescents (AAPC 18.5%, 95% CI 11.9–25.5). Among the foreign-born population, those from countries in the horn of Africa contributed most to the TB caseload.
Conclusion TB notification rate among children was low and constantly declining across different demographic groups. However, heterogeneities were shown in adolescents, with an increasing trend in the foreign-born, particularly those from Africa.
Abstract
During 1993–2018, TB notification in children in the Netherlands declined steadily, but there was an increase of TB in foreign-born adolescents. Enhancing active case-finding through contact investigation and entry screening is needed to optimise TB control. https://bit.ly/36AjNhm
Footnotes
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Author contributions: F. Gafar, N. van't Boveneind-Vrubleuskaya, B. Wilffert and J-W.C. Alffenaar contributed to conception and design of the study. F. Gafar obtained data of TB cases from the Netherlands Tuberculosis Register. T. Ochi undertook data extraction of population numbers from the Central Agency for Statistics. F. Gafar performed data analysis and created tables and figures. F. Gafar, T. Ochi, N. van't Boveneind-Vrubleuskaya, O.W. Akkerman, C. Erkens, S. van den Hof, T.S. van der Werf, J-W.C. Alffenaar and B. Wilffert interpreted the results. F. Gafar and T. Ochi drafted the manuscript. J.W.C. Alffenaar and B. Wilffert supervised the entire project. All authors critically revised the manuscript for important intellectual content and approved the final version of the manuscript.
Conflict of interest: F. Gafar has nothing to disclose.
Conflict of interest: T. Ochi is an employee of BaseClear B.V. (commercial, non-R&D).
Conflict of interest: N. van't Boveneind-Vrubleuskaya has nothing to disclose.
Conflict of interest: O.W. Akkerman has nothing to disclose.
Conflict of interest: C. Erkens has nothing to disclose.
Conflict of interest: S. van den Hof has nothing to disclose.
Conflict of interest: T.S. van der Werf has nothing to disclose.
Conflict of interest: J-W.C. Alffenaar has nothing to disclose.
Conflict of interest: B. Wilffert has nothing to disclose.
Support statement: This study was supported by the University of Groningen and the Indonesia Endowment Fund for Education (LPDP; 201711220412046) through a PhD scholarship awarded to F. Gafar. The funding bodies had no role in the study conception and design, data collection and analysis, writing and reviewing of the manuscript, or decision to publish. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received April 8, 2020.
- Accepted May 22, 2020.
- Copyright ©ERS 2020
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