Evaluation of transmission of Mycobacterium tuberculosis in a pediatric setting

Objective: To determine the extent of transmission of Mycobacterium tuberculosis to pediatric patients exposed to a pediatrician with smear- and culture-positive pulmonary tuberculosis (TB). Methods: Clinic billing and hospital admission records were used to identify patients seen during the pediatrician's infectious period. Patients were notified of the potential exposure and were offered screening. Results: A total of 1416 pediatric patients were identified as exposed. Of the 606 who completed screening, 12 (2%) had a skin test result ≤10 mm, 2 (0.3%) had a result 5 to 9 mm, and 592 (98%) had a negative test result (0 to 4 mm). No active TB cases were identified. Of the 14 children with a skin test result ≤5 mm, 7 were U.S.- born and had no other risk factor for a positive skin test. The remaining seven had either been exposed to another person with infectious TB or were from countries with a high prevalence of TB. Conclusion: We found evidence of limited transmission of Mycobacterium tuberculosis in the outpatient pediatric setting. Despite extensive resource dedication, only 43% of exposed children completed screening. In similar situations decisions should balance the responsibility to protect children exposed to Mycobacterium tuberculosis with other public health priorities and available resources.