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Public-Health Officials Show Concern As Childhood Tuberculosis Increases In North Carolina

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RALEIGH, N.C. — As the number of reported cases of childhood tuberculosis has continued to rise in North Carolina, public-health officials have become increasingly troubled.

Carol Dukes Hamilton, M.D., medical director of North Carolina's Tuberculosis Control Program, said the number of reported cases of childhood TB may have doubled or tripled in the past year.

As of November 2002, 17 cases of TB had been reported in children under 15, compared with only nine cases in 2001. Ten of the 17 cases were in children under the age of 5.

The counties reporting childhood TB cases in 2002 were Duplin, Guilford, Montgomery, New Hanover, Onslow, Pitt, Richmond, Robeson, Wayne, Wake and Wilkes.

Though cause for concern, the incidence of TB in North Carolina follows the trend in other states, with increasing numbers of cases involving adults who once lived in countries where TB still runs rampant. Seven of the 10 children under the age of 5 who had TB in North Carolina last year are of Hispanic ethnicity.

Dr. Hamilton said TB in children can be prevented if the children are started on the right medicines when they have been exposed to the illness.

Also, Dr. Hamilton said, very young children are vulnerable when exposed to adults with TB. That is why she urges adults who may have TB to get treated.

"TB in children indicates that there is an active, often undiagnosed adult with TB in the vicinity," Dr. Hamilton said. "Sometimes, it is a parent who has not yet gone to the doctor, or an adult visiting from a country where TB is common."

Often, Dr. Hamilton said, children are not diagnosed until the adult case in the household is identified.

Typical symptoms of TB in adult include a cough that lasts for more than two weeks, fever, night sweats, poor appetite and fatigue.

Infants with TB often do not cough but will have fever, poor appetite and do not gain weight as expected.

Infants and young children can become severely ill, sometimes with TB meningitis, a brain infection leading to convulsions. Some of those children die.

Dr. Hamilton said that many adults are reluctant to go for testing, noting that many feel embarrassed because of a social stigma that is attached to TB. She added that people in the U.S. without proper documentation may be afraid to report their illness or disclose the names of people they associate with.

"Local health departments statewide provide TB evaluation and treatment services free of charge to those who cannot pay," Dr. Hamilton said. "Health departments treat all members of the community equally, regardless of residency documentation. They do not check residency documents, and they do not report TB cases to the National Immigration Service.

"We want to wipe out TB in this state," Dr. Hamilton said. "People should not hesitate to get tested and treated in North Carolina. That is the only way to protect our children from this dangerous disease."

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