[TUBERCULOSIS ANNUAL REPORT 2013--(2) Tuberculosis in Pediatric and Elderly Patients].

In 2013, 66 patients with pediatric tuberculosis (TB; age range: 0-14 years) were newly notified in Japan, corresponding to a notification rate of 0.40 per 100,000 population. Since 2006, the annual number of notified patients with pediatric TB has been less than 100. Among the 66 patients with pediatric TB who were notified in 2013, 27 (40.9%) were aged 0-4 years, 14 (21.2%) were aged 5-9 years, and 25 (37.9%) were aged 10-14 years. The largest proportion of pediatric TB patients was aged 0-4 years. In 2013, two cases of TB meningitis and no cases of miliary TB were reported in children. Case detection occurred at rates similar to previous years, with 20 patients (30.3%) identified at medical institutions and 33 (50%) via household contact investigations. Since 2000, the number of all elderly patients (aged 65 years or older) with TB had decreased rapidly and remained stable until recently. However, the number of such patients has declined gradually since 2012. The proportion of TB patients aged 65 years or older has consistently increased to as high as 64.5% in 2013; notably, the proportion of TB patients aged 80 years or older has also increased to 36.1%. Since 1999, the TB notification rates in Japan have been consistently higher among patients aged 85 years or older than among those aged 65-84 years. The rate of notification for TB patients aged 65 years or older decreased by 0.6% from 2012 (13,307 patients) to 2013 (13,227 patients). The proportion of bacteriologically positive TB patients among the general population of pulmonary TB (PTB) patients was higher among those aged 65 years or older than among those aged 15-64 years. Among all symptomatic patients, the proportion of PTB patients with only non-respiratory symptoms increased with age to 30.3% among those aged 85 years or older. The proportion of TB patients with a patient delay of two months or longer was lower among patients aged 65 years or older than among those aged 15-64 years (14.2% vs. 25.6%), whereas the proportion of TB patients with a doctor delay of one month or longer was slightly higher among patients aged 65 years or older than among those aged 15-64 years (23.0% vs. 20.3%). Among TB patients aged 65 years or older who were newly notified in 2012, 32.2% died within one year after the initiation of TB treatment; of these patients, 19.2% died within three months. Among patients aged 65 years or older, the proportion of deaths within three months after the initiation of TB treatment increased substantially with age from 7.8% of those aged 65-69 years to 37.7% of those aged 90 years or older.