P52 Rising paediatric tuberculosis in Greater Manchester: epidemiology and BCG vaccination status of cases

Background Tuberculosis cases in Greater Manchester (GM) have increased annually since 2004. The Paediatric TB clinic at Royal Manchester Children9s Hospital has grown since its inception in 2004, but it is unclear as to whether this is due to a true increase in cases or a change in referral patterns. At the same time the uptake of BCG vaccine is sub-optimal. Objectives To investigate the incidence, epidemiology and BCG vaccination eligibility and status of childhood tuberculosis cases in GM between 2006 and 2010. Methods All children (≤16 years) notified through the Enhanced Tuberculosis Surveillance System between 1 January 2006 and 31 December 2010 were identified. Vaccination records were obtained from Primary Care Child Health Systems. Missing data were supplemented with examination of case-notes. Eligibility for BCG vaccine was determined by place of birth and ethnicity. Results 215 children (89 male; mean age 8.8 years) were notified over the 5 years. A rise of 64.5% in overall number of cases was reported from 2006 to 2010. Pakistanis comprised 39.1% of TB cases, Black Africans 28.8% and white British 14.9%. The majority of children were UK-born (60.5%). Of non-UK born cases 67.1% entered the UK within 2 years of their diagnosis. Of 130 UK-born children, 111 were deemed eligible for BCG vaccination. Of these 85 (75.6%) received the vaccine. Of 85 children born outside the UK, vaccination status could not be determined in 8, and one child was ineligible for vaccination. Vaccination was confirmed in 53% of non-UK born children (BCG record or BCG scar). In children who had not received BCG, although the number of cases was very small, a threefold higher risk of more severe forms of infection (military, CNS involvement) was identified. Conclusion There has been a significant rise in incidence of Paediatric TB in GM over the last 5 years. The reason for this remains unclear. However, BCG vaccination uptake rates were poor (75% of UK born individuals and 67% overall). Systems for identifying eligible children and immunising them need to be reviewed and strengthened both for high risk neonates and children entering the country.