Relationship between five common viruses and febrile seizure in children.

OBJECTIVES: To examine the role of viruses in febrile seizures (FS) by comparing the relative risk (RR) of developing FS with common viral infections and subsequent risk of recurrence. METHODS: We matched the medical records of all children admitted with FS over 5 years and the contemporary records for all admissions for febrile illnesses associated with influenza, adenovirus, parainfluenza, respiratory syncytial virus (RSV) and rotavirus to calculate the RR of FS following these viral infections. For patients admitted for a first FS, we carried multivariate analysis for type of viral infection, age of onset, family history, complex FS features and maximum temperature during the episode, to identify the risk factors for recurrence. RESULTS: There were 923 admissions for FS, of which 565 were for first seizures. The five most common viruses in FS were influenza (163/923, 17.6%), adenovirus (63/923, 6.8%), parainfluenza (55/923, 6%), RSV (25/923, 2.7%) and rotavirus (12/923, 1.3%). Incidences of FS in febrile illnesses due to these viruses were 20.8% (163/785) for influenza, 20.6% (55/267) for parainfluenza, 18.4% (63/343) for adenovirus, 5.3% (25/468) for RSV and 4.3% (12/280) for rotavirus. Complex FS occurred in 20.6% (n = 191) and the risk of developing complex FS was similar for the five viruses. Overall recurrence rate was 20.5% and was not predicted by type of viral infection. CONCLUSION: The risk of developing FS is similar with influenza, adenovirus or parainfluenza and is higher than with RSV or rotavirus. Type of viral infection is not important in predicting complex features or future recurrences.     

Respiratory infections for which general practitioners consider prescribing an antibiotic: a prospective study

Objective

To determine the viral aetiology of respiratory infections in children presenting to primary care with “more than a simple cold”.

Design

Observational study in 18 Oxfordshire general practices over four winters (2000–01 to 2003–04).

Patients

425 children aged 6 months to 12 years with cough and fever for whom general practitioners considered prescribing an antibiotic.

Methods

Nasopharyngeal aspirate obtained from 408 (96%) children was subjected to PCR for respiratory viruses. Parents completed an illness diary for the duration of illness.

Results

A viral cause of infection was detected in most (77%) children. Clinical symptoms correctly identified the infecting virus in 45% of cases. The duration of illness was short and the time course was very similar for all infecting viruses. One third of children were prescribed an antibiotic (34%), but this made no difference to the rate of parent‐assessed recovery (Kruskal‐Wallis, p = 0.67). About one in five children with influenza who did not receive an antibiotic had persistent fever on day 7 compared to no children receiving antibiotics (p = 0.02); this difference remained after adjustment for severity and other factors and was not seen with other viruses.

Conclusions

Most children receiving antibiotics for respiratory symptoms in general practice have an identifiable viral illness. In routine clinical practice, neither the specific infecting virus nor the use of antibiotics has a significant effect on the time course of illness. Antibiotics may reduce the duration of fever in children with influenza which could reflect an increased risk of secondary bacterial infection for such children.     

Prediction of vesicoureteral reflux after a first febrile urinary tract infection in children: validation of a clinical decision rule

Aims

To test the reproducibility of a highly sensitive clinical decision rule proposed to predict vesicoureteral reflux (VUR) after a first febrile urinary tract infection in children. This rule combines clinical (family history of uropathology, male gender, young age), biological (raised C reactive protein), and radiological (urinary tract dilation on renal ultrasound) predictors in a score, and provides 100% sensitivity.

Methods

A retrospective hospital based cohort study included all children, 1 month to 4 years old, with a first febrile urinary tract infection. The sensitivities and specificities of the rule at the two previously proposed score thresholds (⩽0 and ⩽5) to predict respectively, all‐grade or grade ⩾3 VUR, were calculated.

Results

A total of 149 children were included. VUR prevalence was 25%. The rule yielded 100% sensitivity and 3% specificity for all‐grade VUR, and 93% sensitivity and 13% specificity for grade ⩾3 VUR. Some methodological weaknesses explain this lack of reproducibility.

Conclusions

The reproducibility of the previously proposed decision rule was poor and its potential contribution to clinical management of children with febrile urinary tract infection seems to be modest.     

Prednisolone versus dexamethasone in croup: a randomised equivalence trial

Background

Croup remains a common respiratory problem presenting to emergency departments. A single oral treatment of oral dexamethasone results in improved outcome. Prednisolone has similar pharmacokinetic properties and has a significant advantage in that it is commercially available in liquid preparations.

Objective

To ascertain whether a single oral dose of prednisolone was equivalent to a single oral dose of dexamethasone (matched for potency) in children with mild to moderate croup.

Design

A double blind, randomised, controlled equivalence trial

Setting

Tertiary paediatric emergency department.

Patients

133 children aged 3 to 142 months presenting with mild to moderate croup.

Interventions

Children received either a single oral dose of dexamethasone 0.15 mg/kg or single oral dose of prednisolone 1 mg/kg.

Outcome

The main outcome measure was unscheduled re‐presentation to medical care as determined by telephone follow up at 7 to 10 days. Croup score, adrenaline (epinephrine) use, time spent in the emergency department, and duration of croup and viral symptoms were secondary outcome measures.

Results

Children treated with prednisolone were more likely to re‐present: 19 of 65 children (29%) reattended medical care compared with 5 of 68 (7%) from the dexamethasone group. The confidence intervals around this 22% difference in outcome were 8% to 35%, outside the 0% to 7.5% range of equivalence. There were no significant differences in other outcome measures.

Conclusion

A single oral dose of prednisolone is less effective than a single oral dose of dexamethasone in reducing unscheduled re‐presentation to medical care in children with mild to moderate croup.     

SIDS risk factors and factors associated with prone sleeping in Sweden

Objective

To compare the current prevalence of risk factors for sudden infant death syndrome (SIDS) in Sweden with a decade earlier, and assess factors associated with prone sleeping.

Methods

The results of a cohort study (Infants of Western Sweden) and a population based case‐control study (Nordic Epidemiological SIDS Study) were examined. Subjects were 5600 healthy 6 month old infants born in 2003 in the Western Sweden region and 430 healthy Swedish infants born between 1991 and 1995.

Results

Prone sleeping decreased from 31.8% to 5.6% and supine sleeping increased from 35.3% to 47.3%. Side or side/supine sleeping increased from 25.2% to 43.8%. Maternal smoking during pregnancy decreased from 23.5% to 9.5%. The risk for prone sleeping increased if the mother was unemployed (OR 2.4, 95% CI 1.5 to 4.0), if she was a heavy smoker in the third trimester (OR 44.1, 95% CI 1.6 to 1199.6), and if the child was irritable (OR 2.5, 95% CI 1.3 to 5.1), shared a bedroom with siblings (OR 2.6, 95% CI 1.0 to 6.6), or never used a dummy (OR 3.2, 95% CI 1.9 to 5.4).

Conclusions

Parents have complied with advice to prevent SIDS given at infant welfare centres for the last 10 years. A change in the preferred sleeping position from side variants to exclusively supine, and reducing the number of pregnant women smoking may be beneficial. Use of a prone sleeping position was associated with maternal employment status, maternal smoking, temperament of the child, dummy use, and sharing a bedroom with siblings.     

Increasing prevalence of hypospadias in Western Australia, 1980-2000

Objectives

Hypospadias, a common birth defect, has shown widespread variation in reported rates and temporal trends across countries over the last 30 years. The aim of this study was to determine the prevalence and trends of hypospadias in an Australian population.

Design

Population‐based study of all male infants born in Western Australia (WA) between 1980 and 2000 diagnosed with hypospadias and notified to the WA Birth Defects Registry.

Main outcome measures

Prevalence of hypospadias, birth outcome and association with other congenital anomalies, stratified by degree‐of‐severity.

Results

1788 cases of hypospadias were registered in WA in 1980–2000 with an overall prevalence of 34.8 (95% confidence interval (CI): 33.2 to 36.4) cases per 10 000 births. The prevalence increased by 2.0% per annum (95% CI: 1.2% to 2.8%) from 27.9 in 1980 to 43.2 per 10 000 births in 2000 (p<0.001). Hypospadias was mild in 84% of cases, moderate‐severe in 11% and unspecified in 5%, with the number of moderate‐severe hypospadias almost doubling over time (p<0.01). There were 1465 (82%) cases of isolated hypospadias and 323 (18%) had co‐existing anomalies. Infants with co‐existing genital (relative risk (RR) 4.5; 95% CI: 3.3 to 6.1) or non‐genital (RR 1.5; 95% CI: 1.0 to 2.2) anomalies were more likely to have moderate‐severe hypospadias compared with isolated cases.

Conclusion

Hypospadias affects one in 231 births and has been reported to have increased significantly over the last 20 years. Future investigation of the aetiology of hypospadias is important to identify potentially modifiable risk factors and ensure optimal male reproductive health in the future.     

Virus detection in critically ill children with acute respiratory disease: a new profile in view of new technology

Aim

To describe the epidemiology of critically ill children admitted to a paediatric intensive care unit (PICU) with acute respiratory disease. The association with intubation was analysed for the three most prevalent viruses and in those with and without viral co‐infection.

Methods

Patients admitted to the PICU (2004–2014) with acute respiratory disease were included. Analyses were performed utilising each respiratory viral infection or multiple viral infections as an exposure.

Results

There were 1766 admissions with acute respiratory disease of which 1372 had respiratory virus testing and 748 had one or more viruses detected. The risk of intubation before or during the PICU stay was higher if parainfluenza virus was detected compared to respiratory syncytial virus (RSV) (OR: 2.20; 95% CI: 1.06–4.56). Sixty‐three admissions had two or more viruses detected, and the combination of RSV and Rhinovirus/enterovirus was the most common. No significant difference was observed in the risk of intubation between patients with multiple and single viral infections.

Conclusion

Higher risk of intubation was found in patients with parainfluenza as compared to RSV. The risk of intubation comparing parainfluenza virus to other viruses and for patients with multiple versus single virus needs to be further studied.

     

Frequency of Common Viruses in Etiology of Acute Respiratory Tract Infections

Objective

To determine the frequency rate of C. pneumoniae, rhinovirus, respiratory syncytial virus (RSV), influenza virus, metapneumovirus, adenovirus’, parainfluenza virus and coronavirus in acute respiratory tract infections in children.

Methods

One hundred nine pediatric patients having respiratory tract infections were included in this study. Real time PCR, DFA and cell culture method were used for detection of C. pneumoniae, RSV antigen and influenza virus respectively. Multiplex PCR was used for detection of other viruses.

Results

No C. pneumoniae DNA was detected in the samples. Virus was detected in 43 cases from larynx swabs (43/109, 39.4 %). The frequency order of the viral agents detected were as follows; rhinoviruses 14.7 %, RSV B 7.3 %, influenza A 6.4 %, metapneumovirus 3.6 %, adenovirus 3.6 %, coronavirus 0.9 %, parainfluenzavirus type 3, 0.9 %, parainfluenzavirus type 4, 0.9 % and RSV A 0.9 %. Sensitivity of the PCR and DFA methods for the diagnosis of RSV infections were detected as 100 % and 100 %, respectively. Specificity of the PCR and DFA methods for RSV infections were detected as 97 % and 100 % respectively. Sensitivity of the PCR and cell culture methods for influenzavirus infections were detected as 100 % and 100 %, respectively. Specificity of the PCR and DFA methods for RSV infections were detected as 96 % and 100 % respectively.

Conclusions

Prevalence of viral agents was detected as 39.4 %. Influenza viruses and RSV were common. Metapneumovirus was also frequent (3.6 %). C. pneumoniae was not found to be a common agent for acute respiratory disease in children.     

2007～2008年温州地区急性呼吸道感染病毒病原学研究

目的：分析2007~2008年温州地区急性呼吸道感染病毒病原学的检测结果,为临床提供病毒病原学诊断依据。方法：取5 097例急性呼吸道感染儿童鼻咽分泌物,采用直接免疫荧光法检测7种常见呼吸道病毒抗原。结果：①2 209份标本（43.3%）病毒病原检测阳性,其中呼吸道合胞病毒（RSV）1 725例（78.1%）,腺病毒（ADV） 61例（2.8%）,流感病毒A型（IVA）66例（3.0%）,流感病毒B型（IVB）12例（0.5%）,副流感病毒1型（PIV1）38例（1.7%）,副流感病毒2型（PIV2）7例（0.3%）,副流感病毒3型（PIV3）275例（12.4%）;②病毒检出率在小于3个月和小于6个月年龄组较高,分别为53.6% 和49.2%;③冬季病毒检出率最高。结论：2007～2008年温州地区急性呼吸道感染的病毒仍以RSV为主要病原体, ＜6个月的婴幼儿病毒感染率较高,好发于冬季。［中国当代儿科杂志,2010,12（1）：32-34］     

Prevalence rates for constipation and faecal and urinary incontinence

Objective

To evaluate the prevalence rates for constipation and faecal and urinary incontinence in children attending primary care clinics in the United States.

Methods

Retrospective review of case records of all children, 4–17 years of age, seen for at least one health maintenance visit during a 6 month period and followed from birth or within the first 6 months of age in our clinics. We reviewed all charts for constipation, faecal incontinence and urinary incontinence.

Results

We included 482 children in the study, after excluding 39 children with chronic diseases. The prevalence rate for constipation was 22.6% and was similar in boys and girls. The constipation was functional in 18% and acute in 4.6%. The prevalence rate for faecal incontinence (⩾1/week) was 4.4%. The faecal incontinence was associated with constipation in 95% of our children. The prevalence rate for urinary incontinence was 10.5%; 3.3% for daytime only, 1.8% for daytime with night‐time and 5.4% for night‐time urinary incontinence. Faecal and urinary incontinence were significantly more commonly observed in children with constipation than in children without constipation.

Conclusion

The prevalence rates were 22.6% for constipation, 4.4% for faecal incontinence and 10.5% for urinary incontinence in a US primary care clinic. Children with constipation had higher prevalence rates for faecal and urinary incontinence than children without constipation. Boys with constipation had higher rates of faecal incontinence than girls with constipation.     

Vaccine-related pain: randomised controlled trial of two injection techniques

Objective

To compare acute pain response during immunisation in infants using a slow standard of care injection technique versus a rapid pragmatic technique.

Design

Randomised controlled trial.

Setting

Single‐centre, urban paediatric primary care practice.

Subjects

Healthy infants 4–6 months of age receiving their routine DPTaP‐Hib immunisation.

Interventions

Standard of care group: slow aspiration prior to injection, slow injection and slow withdrawal. Pragmatic group: no aspiration, rapid injection and rapid withdrawal.

Main outcome measures

Immediate infant pain measured by the Modified Behavior Pain Scale (MBPS), crying and parent/paediatrician visual analogue scale (VAS).

Results

113 infants participated; there were no observed differences in age, birth order or prior analgesic use. Mean MBPS scores (95% confidence interval (CI)) were higher (p<0.001) for the standard group compared to the pragmatic group, 5.6 (5 to 6.3) vs 3.3 (2.6 to 3.9). The standard group was more likely to cry, 47/57 (82%) vs 24/56 (43%), to cry longer, median (interquartile range (IQR)) 14.7 s (8.7–35.6) vs 0 s (0–11.30), and to take longer to have the vaccine injected, median (IQR) 8.8 s (7.9–10.3) vs 0.9 s (0.8–1.1), p<0.001 for all comparisons. The median (IQR) VAS scores by parents and paediatricians were higher for the standard group: VAS parent, 3.5 (1.6–5.5) vs 1.9 (0.1–3.1) and VAS paediatrician, 2.8 (2.0–5.1) vs 1.4 (0.2–2.4). There were no adverse events.

Conclusion

Immunisation using a pragmatic rapid injection technique is less painful than a slow standard of care technique and should be recommended for routine intramuscular immunisations.     

Isotonic is better than hypotonic saline for intravenous rehydration of children with gastroenteritis: a prospective randomised study

Aims

To determine whether the risk of hyponatraemia in children with gastroenteritis receiving intravenous (IV) fluids is decreased by the use of 0.9% saline.

Methods

A prospective randomised study was carried out in a tertiary paediatric hospital. A total of 102 children with gastroenteritis were randomised to receive either 0.9% saline + 2.5% dextrose (NS) or 0.45% saline + 2.5% dextrose (N/2) at a rate determined by their treating physician according to hospital guidelines and clinical judgement. Plasma electrolytes, osmolality, and plasma glucose were measured before (T₀) and 4 hours after (T₄) starting IV fluids, and subsequently if clinically indicated. Electrolytes and osmolality were measured in urine samples. Results were analysed according to whether children were hyponatraemic (plasma sodium <135 mmol/l) or normonatraemic at T₀.

Results

At T₀, mean (SD) plasma sodium was 135 (3.3) mmol/l (range 124–142), with 37/102 (36%) hyponatraemic. At T₄, mean plasma sodium in children receiving N/2 remained unchanged in those initially hyponatraemic (n = 16), but fell 2.3 (2.2) mmol/l in the normonatraemic group. In contrast, among children receiving NS, mean plasma sodium was 2.4 (2.0) mmol/l higher in those hyponatraemic at baseline (n = 21) and unchanged in the initially normonatraemic children. In 16 children who were still receiving IV fluids at 24 hours, 3/8 receiving N/2 were hyponatraemic compared with 0/8 receiving NS. No child became hypernatraemic.

Conclusions

In gastroenteritis treated with intravenous fluids, normal saline is preferable to hypotonic saline because it protects against hyponatraemia without causing hypernatraemia.     

The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal events

Aims

To determine the proportion of children admitted with difficult to treat paroxysmal events to a tertiary epilepsy centre who did not have epilepsy.

Methods

In an observational retrospective study, all case notes of 223 children admitted in 1997 were examined. The referral was made from the local paediatric department in 51% of cases, other departments in 27%, and from general or specialist practitioners in 22%. Doubt regarding the diagnosis of epilepsy was expressed in the referral note in 17%. On admission, 86% were on antiepileptic drug treatment. During admission all children were subjected to a comprehensive intensive observation and 62% had EEG monitoring.

Results

In total, 39% (87/223) were found not to have epilepsy. In 30% of children (55/184) referred without any doubts about the epilepsy diagnosis, the diagnosis was disproved. Of the 159 children admitted for the first time, 75 (47%) were discharged with a diagnosis of non‐epileptic seizures. Of 125 children admitted for the first time with no doubts about the diagnosis of epilepsy, 44 (35%) did not have epilepsy. Staring episodes were the most frequently encountered non‐epileptic paroxysmal event. Psychogenic non‐epileptic seizures were found in 12 children. A total of 34 (15%) had their medication tapered off; a further 22 (10%) had tapered off medication before admission.

Conclusion

The present study supports the view that misdiagnosis of epilepsy is common. The treating physician should be cautious in diagnosis, especially of staring episodes. A diagnostic re‐evaluation should be undertaken in difficult cases with continuing paroxysmal events in order to avoid unnecessary drug treatment and restrictions on the child''s lifestyle.     

Value of fast indirect immunofluorescence diagnosis of respiratory viruses]

Four hundred and three nasopharyngeal aspirates from hospitalized children have been analysed for RSV, influenza A and B, parainfluenza 3, adenovirus, with Monofluor Kits Diagnostics Pasteur. One hundred and seventeen positive samples were found, RSV: 69, influenza A: 17, influenza B: 12, parainfluenza 3: 2 and adenovirus: 17. Rapid diagnosis of viral diseases allows to decrease the incidence of nosocomial infections, to watch over infants carrying RSV who might develop severe bronchiolitis. This technique combined with anatomic examination showed that sudden death occurred, in 7 of 15 infants, during an acute respiratory infection (RSV: 6).     

Breast feeding and resilience against psychosocial stress

Background

Some early life exposures may result in a well controlled stress response, which can reduce stress related anxiety. Breast feeding may be a marker of some relevant exposures.

Aims

To assess whether breast feeding is associated with modification of the relation between parental divorce and anxiety.

Methods

Observational study using longitudinal birth cohort data. Linear regression was used to assess whether breast feeding modifies the association of parental divorce/separation with anxiety using stratification and interaction testing. Data were obtained from the 1970 British Cohort Study, which is following the lives of those born in one week in 1970 and living in Great Britain. This study uses information collected at birth and at ages 5 and 10 years for 8958 subjects. Class teachers answered a question on anxiety among 10 year olds using an analogue scale (range 0–50) that was log transformed to minimise skewness.

Results

Among 5672 non‐breast fed subjects, parental divorce/separation was associated with a statistically significantly raised risk of anxiety, with a regression coefficient (95% CI) of 9.4 (6.1 to 12.8). Among the breast fed group this association was much lower: 2.2 (−2.6 to 7.0). Interaction testing confirmed statistically significant effect modification by breast feeding, independent of simultaneous adjustment for multiple potential confounding factors, producing an interaction coefficient of −7.0 (−12.8 to −1.2), indicating a 7% reduction in anxiety after adjustment.

Conclusions

Breast feeding is associated with resilience against the psychosocial stress linked with parental divorce/separation. This could be because breast feeding is a marker of exposures related to maternal characteristics and parent–child interaction.     

Increased burden of respiratory viral associated severe lower respiratory tract infections in children infected with human immunodeficiency virus type-1

OBJECTIVES: To determine the burden of viral associated severe lower respiratory tract infections (SLRTI) in human immunodeficiency virus-infected (HIV+) and HIV-uninfected (HIV-) urban black South African children. METHODS: Children with SLRTI aged 2 to 60 months were enrolled between March 1997 and March 1998. Monoclonal antibody immunofluorescent testing was performed on nasopharyngeal aspirates to detect respiratory syncytial virus (RSV), influenza A and B, parainfluenza 1-3, and adenovirus-specific antigens. RESULTS: Of the 990 children studied, 44.6% were HIV+. The estimated burden of disease of viral associated SLRTI in children under 2 years was increased for RSV, influenza A/B viruses, parainfluenza 1-3 viruses, and adenovirus in children who were HIV+ compared with children who were HIV- (P <.001). Viral pathogens, however, were identified less frequently (15.7% vs 34.8%, P < 10(-5)) and bacterial pathogens more frequently (12.5% vs 5.8%, P <.0001) in children who were HIV+ than in children who were HIV- and had SLRTI. The seasonal peak for RSV in late summer-early autumn observed in children who were HIV- was less evident in children who were HIV+ (P =.02). Children who were HIV+ and had virus-associated SLRTI had a higher mortality rate (7. 5%) than did children who were HIV- (0%, P < 10(-3)). CONCLUSIONS: The contribution of viral associated SLRTI differs between HIV+ and HIV- children. In HIV+ children in South Africa, RSV isolation is not limited by season.     

Acceptability of perinatal rapid point-of-care HIV testing in an area of low HIV prevalence in the UK

Objective

To determine the uptake of current antenatal HIV testing, the prevalence of risk factors for HIV in pregnant women and the acceptability of the rapid point‐of‐care HIV test (RPOCT) among pregnant women and their midwives.

Design

A retrospective review of 717 notes to determine current HIV screening practices and a cross‐sectional survey using a self‐completed questionnaire for pregnant women and midwives.

Setting

The antenatal clinic (ANC) and postnatal wards (PNW) at a university teaching hospital in the West Midlands.

Participants

486 women attending the ANC or admitted to the PNW during a fortnight in May–June 2006. 72 midwives on the delivery ward completed a second questionnaire.

Results

The questionnaire showed that 90.4% of those offered the standard HIV test accepted it, with 7.2% having at least one risk factor for HIV. Over half of the decliners perceived themselves as not at risk. 85.2% would accept the rapid test, including 35.6% of the decliners. 92.8% of midwives agreed/strongly agreed the RPOCT has a role on the delivery ward and 97.2% would be happy to offer the test with appropriate training and guidance.

Conclusions

Midwives deem the RPOCT to be appropriate for a variety of perinatal settings. It is also acceptable to a clinically significant proportion of those who decline the standard test (21 of 59) and therefore has the potential to increase screening and detection rates. Hence, by allowing early diagnosis and the initiation of antenatal interventions, it could reduce the rate of mother‐to‐child transmission (MTCT) in the UK.     

Active surveillance for tuberculosis in Wales: 1996-2003

Aims

To estimate the incidence of active tuberculosis (TB) and study the use of chemoprophylaxis for latent TB in children in Wales, and to identify potential areas for improving prevention and management.

Methods

Active surveillance for TB in children aged 0–15 years from July 1996 to December 2003, using the Welsh Paediatric Surveillance Scheme.

Results

A total of 232 children, 102 with active TB (2.3 per 100 000) and 130 with latent TB (2.9 per 100 000), were identified. Nearly half (45%) belonged to ethnic minorities (19% were of black African origin), a much higher proportion than the base population. Pulmonary disease was the most common presentation (47%), including six (9%) children who were sputum smear positive. There were 10 cases of disseminated TB, nearly all in white children under 10 years of age. Less than two thirds of eligible children (27/46, 59%) were known to have received BCG immunisation. The source of infection was an adult household contact in most cases, but was not known in 44 cases, particularly among teenagers. Four community outbreaks occurred during the surveillance period, including three in high schools.

Conclusion

TB incidence in children in Wales remains low, but the epidemiology is changing with an increasing proportion of cases in black African children. The high proportion of patients with disseminated TB is of particular concern. TB in teenagers was often associated with school outbreaks. Many eligible children do not receive BCG immunisation, indicating further scope for prevention.