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Tuberculosis screening in internationally adopted children: the need for initial and repeat testing.

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Repeat tuberculosis testing for internationally adopted children is crucial. This approach identifies more cases of latent tuberculosis infection, which is common in this population, preventing active disease.

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Area of Science:

  • Infectious Diseases
  • Pediatrics
  • Public Health

Background:

  • Internationally adopted children often originate from high tuberculosis prevalence areas.
  • Tuberculosis screening is recommended upon arrival to the United States.

Purpose of the Study:

  • To evaluate the effectiveness of repeat tuberculin skin testing in identifying latent tuberculosis infection (LTBI) in internationally adopted children.
  • To determine if repeat testing identifies additional cases missed by initial screening.

Main Methods:

  • A cohort of internationally adopted children underwent initial tuberculin skin testing within two months of arrival.
  • Children with negative initial tests were retested at least three months later.
  • Prevalence of LTBI and potential risk factors were analyzed.

Main Results:

  • 21% of 527 children had LTBI on initial testing.
  • Repeat testing of 191 children (initially negative) revealed LTBI in 20% of this subgroup.
  • No active tuberculosis disease was diagnosed.
  • BCG immunization showed a strong correlation with tuberculin skin test results.

Conclusions:

  • Latent tuberculosis infection is highly prevalent in internationally adopted children.
  • A significant proportion of children have initially false-negative tuberculin skin tests.
  • Repeat tuberculosis testing should be standard care for this high-risk population to prevent tuberculosis disease.