June 1, 2000

BIRMINGHAM, AL — Cases of childhood tuberculosis (TB) increased by 20 percent in Alabama over the last decade, despite a declining trend among children and adults nationwide, according to a recent study by Dr. Michael Kimerling, assistant professor of medicine with UAB's Division of General and Internal Medicine. Results of the study were published in the April issue of Pediatrics.

An important factor influencing the rise of TB among children in the state was the failure of family members to report a child's exposure to someone with active TB, according to the study. "In nearly half of preventable cases, the family did not report that a child had come in contact with someone who had TB," says Kimerling. "Another important factor is parents who fail to take their preventive therapy, then develop active TB and pass it along to their children."

From 1992 to 1997, there were 120 cases of childhood TB in Alabama. The study shows that significantly more cases were reported among minority children than white children, and all preventable cases were reported among black children. "Once a child is exposed, TB can be prevented if he/she receives preventive treatment before the infection becomes active," says Kimerling. "Of the childhood TB cases identified in the study, 21 percent were preventable."

The reason families are reluctant to report a child's exposure is unclear. "Perhaps there are socio-cultural barriers between the Health Department and certain minority families," says Kimerling. "It is more likely a socio-economic issue rather than one of race, since the Health Department is well-mixed racially, but there is obviously something going on within these families and households that we don't understand."

Although access to care is a statewide issue in Alabama, Kimerling said it doesn't come into play with childhood TB. "Physical access to care is not the issue, since all care is provided at home and free of charge. The bigger problem is access to exposed family members, particularly children."

Reducing and preventing childhood TB in Alabama hinges on improving the efficiency and effectiveness of the contact investigation process, says Kimerling. "If we can identify and prevent latent infections from developing into the disease stage, then we can prevent future cases of transmission from one person to another, but investigators must work quickly. Unidentified, untreated persons with TB infection represent a reservoir of future disease transmission."