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- BOSTON (Reuters) - The conventional
wisdom among doctors is that young children rarely spread tuberculosis.
A new case reported in Thursday's New England Journal of Medicine said
the conventional wisdom is wrong.
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- Federal and state health investigators identified a 9-year-old
North Dakota boy, a native of the Marshall Islands in the Pacific Ocean,
who passed TB to 16 classmates, 10 on his school bus, and three out of
four people living in his house.
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- A total of 118 people exposed to the boy, including 56
young children, ultimately needed some type of therapy to either prevent
the lung-dissolving infection or to block its spread to others, the Journal
reported.
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- Ironically, the child was given a tuberculin skin test
when he arrived in the United States in 1996. But the test was never read,
the Journal said.
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- ``Children with tuberculosis ... should be considered
potentially infectious, and their cases may merit investigations of contacts
as extensive as the one described here,'' according to researchers led
by Amy Curtis of the U.S. Centers for Disease Control and Prevention in
Atlanta.
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- Children were not regarded as capable of spreading the
disease because youngsters under age 10 usually can't produce a cough powerful
enough to propel TB particles into the air. An evaluation of 84 school-based
outbreaks in 12 countries, published in 1965, found only four cases where
a child younger than 10 was the source of the infection.
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- In the North Dakota case, investigators identified the
child when his female guardian, 36, was found to have tuberculosis in her
left hip. TB in unusual cases can attack parts of the body other than the
lungs.
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- The boy and his twin brother, who was not infected, had
come from the Republic of the Marshall Islands where TB is common.
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- In an editorial in the Journal, Dr. Laurie Miller of
the Floating Hospital for Children in Boston said the case ''emphasizes
the need for careful screening and follow-up of children born outside the
United States'' for TB and other diseases.
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- Youngsters are supposed to receive physical examinations
as part of the visa process, she said, but ``the evaluation is usually
cursory.''
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- Overseas vaccinations may be inadequate, so ``questionable
immunizations should be repeated'' or the children should be tested for
immunity to key diseases, she said.
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- In particular, she said, ``adopted children from outside
the borders of the United States constitute a special population that deserves
focused medical attention. Public and personal health considerations demand
that these children receive careful evaluations on arrival in the United
States and at follow-up.''
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