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Risk factors for latent tuberculosis infection among children in New York City
L Saiman1, P San Gabriel, J Schulte
1Department of Pediatrics, Columbia University, New York, New York 10032, USA. ls5@columbia.edu
Insights
Identifying risk factors for latent tuberculosis (TB) infection in children is crucial for TB control. Contact with active TB cases, foreign birth, and travel were key predictors in a US study. This helps refine screening for pediatric populations.
Area of Science:
- Pediatric infectious diseases
- Public health surveillance
- Tuberculosis epidemiology
Background:
- Latent tuberculosis (TB) infection (LTBI) identification and treatment are critical for TB control in the US.
- Limited data exist on risk factors for LTBI in pediatric populations, hindering targeted screening efforts.
Purpose of the Study:
- To identify risk factors for LTBI in children aged 1 to 5 years.
- To inform targeted screening strategies for pediatric TB in the United States.
Main Methods:
- A matched case-control study was conducted in 24 primary care clinics in Northern Manhattan and Harlem.
- Cases had LTBI (TST ≥10 mm, normal chest radiograph); controls had negative TSTs (0 mm).
- Medical records were reviewed, and parental questionnaires were administered to determine risk factors.
Main Results:
- Contact with an adult with active TB, foreign birth, foreign travel, and a relative with a positive TST were significant predictors of LTBI.
- A history of a previous negative TST was protective against LTBI.
- BCG immunization was not an independent risk factor for a positive TST in this population.
Conclusions:
- Several key risk factors for pediatric LTBI were identified.
- These findings can refine targeted TB surveillance, particularly among Hispanic immigrant children in the US.
Objective:
Although identification and appropriate treatment of children with latent tuberculosis (TB) infection (LTBI) is considered critical to the control and elimination of TB in the United States, there are limited data on risk factors for LTBI in pediatric populations.
Methods:
To further improve targeted screening for LTBI, we performed a matched case-control study from September 1996 to December 1998. We actively surveyed 24 primary care clinics serving Northern Manhattan and Harlem twice monthly for case participants 1 to 5 years old with LTBI, defined as a child with a Mantoux tuberculin skin test (TST) >/=10 mm and a normal chest radiograph. Two age- and clinic-matched control participants with TSTs equal to 0 mm were enrolled per case. To determine risk factors for LTBI, a bilingual research worker reviewed the medical records of study participants and administered a questionnaire to the parents of participants.
Results:
We enrolled 96 cases and 192 controls whom did not differ by age, gender, ethnicity, and race; overall, the mean age of participants was 2.9 years, 51% were male, 80% were Hispanic, and 9% black. Logistic regression analysis demonstrated that contact with an adult with active TB, foreign birth, foreign travel, and a relative with a positive TST were predictive of case status. In contrast, a history of a previous negative TST proved protective and BCG immunization was not an independent risk factor for a positive TST, suggesting that boosting was not important in this population.
Conclusions:
We identified several risk factors for LTBI in children that can be used to refine targeted surveillance for TB among Hispanic immigrant populations in the United States.