While the incidence of TB in industrialised countries has fallen to very low levels with improving living conditions, in the United States the steady decline in incidence of TB has halted. This increase was the result of an association of HIV infection and TB, increasing poverty, immigration from countries with high TB prevalence, and decreased public health funding. Tuberculosis is not presently a major problem in Australia. While most TB notifications are made from New South Wales and Victoria, the rate of notifications is highest in the Northern Territory. 7-9 Childhood tuberculosis Starke 10 has emphasised the differences between paediatric and adult tuberculosis.
Children generally have a much smaller bacterial population and there is less secondary resistance.
Cavitary lesions are very rare, but children have a greater propensity for extrapulmonary disease. Paediatric tuberculosis is usually acquired from contact with an infected adult, and children with TB are generally at low risk of infecting others. Given the low incidence of childhood cases, this variety of attending specialists is not surprising and does not necessarily mean that current management of paediatric TB is inappropriate. In large cities there may be enough children with TB or receiving preventive therapy to warrant specialised paediatric TB clinics that combine both paediatric and public health expertise. However, in many parts of Australia, children with TB or TB contact are managed in chest clinics by chest physicians who are expert in tuberculosis, but may lack paediatric knowledge and skills.