Journal article


Background: Sydney has a large and highly mobile immigrant community. The pattern of paediatric tuberculosis (TB) disease in this highly cosmopolitan city is not well documented.

Methods: We reviewed data on all children notifed with TB in New South Wales (NSW), Australia, from January 2014 to December 2015, complemented by an expanded dataset for children managed within the Sydney Children’s Hospitals Network (SCHN).

Results: Over the 2-year study period, 921 TB cases were identifed in NSW, including 26 (2.8%) children younger than 15 years of age. Of 23 children and adolescents treated for TB in the SCHN, 21 (91.3%) had a history of recent immigration from, or travel to, a country with high TB incidence, and 7 (30.4%) reported contact with an infectious TB case in Australia. Fourteen (60.9%) children had microbiologically confrmed TB; of these, 5 (21.7%) had acid-fast bacilli on microscopy, 8 (34.8%) were positive by polymerase chain reaction and 11 (47.8%) were positive by culture. All Mycobacterium tuberculosis isolates were susceptible to frst-line drugs. Ten (43.5%) cases were not vaccinated with bacille Calmette–Guérin (BCG), including all cases with severe disease: 2 with disseminated (miliary) TB and 3 with tuberculous meningitis.

Conclusion: Our findings emphasise the need for improved TB prevention and surveillance in children at high risk of exposure, particularly young children travelling to areas of high TB incidence.

Key points:

  • Children diagnosed with tuberculosis (TB) in the Sydney Children’s Hospitals Network presented with a broad spectrum of disease
  • Severe disease (tuberculous meningitis or disseminated disease) most frequently occurred among Australian-born children who were not vaccinated with bacille Calmette–Guérin (BCG)
  • Recent (within the past year) TB exposure, most commonly resulting from a visit to, or migration from, a TB-endemic country, was the leading risk factor associated with childhood TB; it was present in more than 90% of cases
  • Childhood TB prevention strategies should consider BCG vaccination (for future TB exposure) and targeted screening (for past TB exposure)


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