Nordholm AC, Holden IK, Hartling UB, et al. - As immigrants represent most pediatric tuberculosis (TB) cases in Western Europe, researchers sought to stratify the data by first/second-generation immigrants. They examined demographic, clinical, microbiologic and treatment outcome data from children < 18 years with TB from 2009 to 2014 in Denmark using registers and medical records. Among 145 identified cases; 99 were immigrants (68%) of which 54 (55%) were second-generation immigrants. Passive case finding led to diagnosis in most first-generation immigrants (73%) and in half the second-generation immigrants (52%), in contrast to Danish children who were mostly diagnosed by active case finding (70%). Often, symptoms were nonspecific, and normal blood tests were reported in one-third of the children at time of diagnosis. Immigrant children comprised the majority of pediatric patients with symptomatic TB in Denmark, whereas diagnosis at earlier disease stages was more frequent among Danish children. Almost one-third of TB cases may represent missed opportunities to prevent TB disease. For improvements, they highlight increasing adult case detection with comprehensive contact investigation among children, tailoring screening and vaccination of immigrant children, and raising awareness of diagnosing and managing latent TB infection in children.