Abstract
BackgroundIdentifying and prioritizing at-risk populations is critical for pediatric tuberculosis control. We aimed to identify a latent tuberculosis infection (LTBI) screening strategy that is appropriate for the Chinese context among children with different TB exposure levels and to explore its clinical importance.MethodsDuring 2013–2015, we enrolled hospitalized children with suspected respiratory infectious disease (RID) for LTBI screening using the tuberculin skin test (TST) and interferon-γ release assay (IGRA) T-SPOT.TB as part of a work up for their RID. Participants with confirmed diagnosis were classified into three subgroups according to level of exposure to TB: no reported contact risk, with household contact risk, and with non-household contact risk.ResultsA total 6202 children (median age: 4.76 years; interquartile range: 1.0–8.0 years) were enrolled. Children with no reported contact risk had the lowest proportions of positive results for the IGRA (0.7%) and TST (3.3%). The proportion of positive results for each test was higher for household contacts than non-household contacts. The TST positive proportion was much higher than that for the IGRA in all three groups. Children with IGRA+/TST+ results had larger indurations than those with IGRA− /TST+ results (15 mm vs. 13 mm, P = 0.02). For IGRA, older age (> 5 years) and non-household or household contact risk were associated with a positive result.ConclusionsPositive IGRA results in children with a contact risk can serve as a critical reference for LTBI management. IGRA can be used, in preference to TST, for Chinese children with a TB exposure risk.
Highlights
Identifying and prioritizing at-risk populations is critical for pediatric tuberculosis control
85 children were diagnosed with active TB (42 children had a contact history to active TB and 43 children had no contact history) and 6202 children were diagnosed with respiratory infectious disease (RID) (369 children had a contact history to active TB and 5833 children had no contact history)
We determined the proportion of positive interferon-gamma release assay (IGRA) and TST results among 6202 children in whom active TB was ruled out according to different exposure levels
Summary
Identifying and prioritizing at-risk populations is critical for pediatric tuberculosis control. We aimed to identify a latent tuberculosis infection (LTBI) screening strategy that is appropriate for the Chinese context among children with different TB exposure levels and to explore its clinical importance. The World Health Organization (WHO) provides guidelines for identifying and prioritizing at-risk populations for targeted interventions of LTBI testing and. Sun et al BMC Infect Dis (2021) 21:815 treatment [6, 7]. Considering the cost of LTBI testing and treatment, the influence of Bacillus Calmette–Guérin (BCG) vaccination and necessary laboratory conditions for these testing methods, the LTBI screening strategy varies among different counties. A TST-only strategy has been used in France whereas the combined use of IGRA and TST has been applied in Germany, comprising an IGRA following a positive TST result, for contact investigation among children [8]
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