New guidelines about latent tuberculosis infection in children and adolescents: a welcome advancement.

Abstract

In a supplement to this month’s issue of Pediatrics , comprehensive new guidelines are being published on finding and treating latent tuberculosis infection (LTBI) in children and adolescents.1 The collaborative group responsible for the guidelines is composed of health professionals from US health departments, the National Tuberculosis Model Centers, academic institutions, and the Centers for Disease Control and Prevention. With these guidelines, pediatricians have a single comprehensive reference about preventing tuberculosis (TB) in their patients. The guidelines are founded on a paradigm that is evolving with the TB epidemiology for US children and adolescents. Although TB rates have been declining overall since 1992, infections and cases have become even more concentrated among high-risk groups such as children born outside the United States. Thus, these guidelines recommend that children should be screened for risk factors for TB and LTBI and tested with the tuberculin skin test only if at least 1 risk factor is present. These guidelines discourage the use of administrative or mandated tuberculin skin tests for entry to child care, school, or summer camp, because these they are likely to consume limited resources but yield very little in finding current cases or preventing future ones. For these settings and most others, testing should be undertaken only if (1) preceded by screening for risk factors as described in the guidelines and (2) coupled to systems that start children who have LTBI on treatment and help them to complete it. The authors of … Reprint requests to (L.J.N.) Division of TB Elimination, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-10, Atlanta, GA 30333. E-mail: lnelson{at}cdc.gov