Related Experiment Video
Updated: Feb 28, 2026
Author Spotlight: Optimizing CFU Determination for Efficient Assessment of TB Vaccine Efficacy and Antigen Presentation Analysis
Published on: July 28, 2023
Tuberculosis screening in internationally adopted children: the need for initial and repeat testing
Indi Trehan1, Jareen K Meinzen-Derr, Linda Jamison
1Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio 45229-3039, USA.
Insights
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.
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.
Objective:
Because most internationally adopted children come from areas of high tuberculosis prevalence, an initial tuberculin skin test is recommended after arrival to the United States. We evaluated whether repeat testing of children >or=3 months after arrival to the United States would identify additional children with latent tuberculosis infection.
Methods:
Internationally adopted children who were seen at our International Adoption Center and had a tuberculin skin test within 2 months of arrival to the United States were eligible for the study. Children not diagnosed with tuberculosis with initial testing were retested at least 3 months later. The prevalence of tuberculosis on arrival and after repeat testing was determined, and potential risk factors for infection were examined.
Results:
Of the 527 internationally adopted children with an initial tuberculin skin test completed, 111 (21%) had evidence of latent tuberculosis infection. Repeat tuberculosis testing was complete for 191 internationally adopted children (46.9% of those who had an initially negative tuberculin skin test). Latent tuberculosis infection was found in 20% of those who were retested. No children were found to have active tuberculosis disease. Children with an initially positive tuberculin skin test result had slightly higher weight-for-age z scores at their initial clinic visit, whereas those whose tuberculin skin test result was positive after repeat testing had slightly lower weight-for-age z scores. A strong correlation between BCG immunization and tuberculin skin test result was observed.
Conclusions:
Latent tuberculosis infection is common in internationally adopted children. A high proportion of internationally adopted children had an initially false-negative tuberculin skin test. Repeat tuberculosis testing of all internationally adopted children with an initially negative tuberculin skin test should be the standard of care for identifying tuberculosis infection and preventing tuberculosis disease in this high-risk population.
Related Concept Videos
01:26Pulmonary Tuberculosis IV
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
01:31Pulmonary Tuberculosis III
The first classification is based on the development of the disease, and it includes the following categories:
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:28Pulmonary Tuberculosis II
Here is a detailed explanation of its pathophysiology:
Transmission: The process begins when a person inhales droplet nuclei containing M. tuberculosis. These are typically released into the air when an individual with pulmonary or...