Tuberculosis among foreign-born children in the State of Florida, 1993--1999: a re-emergence phase after a sustained decline?

Study objective: To determine the temporal trend of tuberculosis disease among foreign-born children in the State of Florida.

Design and setting: Descriptive population-based study on data obtained from the Tuberculosis Control and Surveillance Program in the State of Florida. We employed Poisson assumption to derive estimates for rates of tuberculosis among US-born and foreign-born children in the studied population. We also applied linear and nonlinear regression equations to describe the best trajectories for observed temporal trends in incidence cases of the disease.

Patients: All cases of tuberculosis disease among children notified in the State of Florida between 1993 and 1999 inclusive.

Main results: The incidence rate of TB over the study period was five times higher among foreign-born children (11.3 per 105; CI = 8.0-14.6 per 105) as compared to US-born (1.7 per 105; CI = 0.8-4.2 per 105). Whereas, new cases of TB among US-born children have continuously and significantly dropped throughout the period of study, our data indicated that the decline achieved from 1993 to 1996 among foreign-born children has ceased, and a resurgence of tuberculosis in this population was apparent.

Conclusions: Our data tend to suggest a re-emergence of tuberculosis among foreign-born children in the State of Florida as from 1997 after several years of decline. There is a need for a more in-depth investigation to elucidate and address causes responsible for the resurgence if the current battle to eliminate tuberculosis from the State is to succeed.