TY - JOUR T1 - Towards elimination of childhood and adolescent tuberculosis in the Netherlands: an epidemiological time-series analysis of national surveillance data JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01086-2020 SP - 2001086 AU - Fajri Gafar AU - Taichi Ochi AU - Natasha van't Boveneind-Vrubleuskaya AU - Onno W. Akkerman AU - Connie Erkens AU - Susan van den Hof AU - Tjip S. van der Werf AU - Jan-Willem C. Alffenaar AU - Bob Wilffert Y1 - 2020/01/01 UR - http://erj.ersjournals.com/content/early/2020/05/26/13993003.01086-2020.abstract N2 - 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 percent 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%] of 1755 children and 1693 [78.9%] of 2144 adolescents). Overall notification rate in children was 2.3/100 000 person-years, declining steadily during the study period (AAPC: −10.9%; 95% CI: −12.6 to −9.1). In adolescents, overall notification rate was 8.4/100 000 person-years, strongly increasing during 1993–2001 and 2012–2018. Compared to Dutch-born, substantially higher notification rates were observed among African-born children and adolescents (116.8/100 000 and 316.6/100 000 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.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Gafar has nothing to disclose.Conflict of interest: Mr. Ochi reports other activity (commercial, non-R&D) from BaseClear B.V., outside the submitted work;.Conflict of interest: Dr. van't Boveneind-Vrubleuskaya has nothing to disclose.Conflict of interest: Dr. Akkerman has nothing to disclose.Conflict of interest: Dr. Erkens has nothing to disclose.Conflict of interest: Dr. van den Hof has nothing to disclose.Conflict of interest: Dr. van der Werf has nothing to disclose.Conflict of interest: Dr. Alffenaar has nothing to disclose.Conflict of interest: Dr. Wilffert has nothing to disclose. ER -