[Comparison of various tuberculosis screening strategies based on tuberculin testing in schoolchildren in Paris]

Following the discontinuation in 2004 of routine tuberculin testing in children in France, we have performed a study aiming at assessing the relevancy and identifying the best modalities of continuation of tuberculosis screening activities in schoolchildren in Paris.

The study was conducted in children attending the last grade of primary school. A preliminary case control study was carried out in order to identify risk factors for abnormal tuberculin test results. Data on tuberculin testing activities conducted in 2004 were analyzed in order to compare the impact and the efficiency of five different target populations for screening. The impact of each of the screening strategies was assessed as the number of tuberculosis infections for which a specific treatment has been proposed and their efficiency as the average number of tuberculin tests needed to identify such an infection.

Beside multiple BCG vaccinations, the main risk factor for an abnormal tuberculin test result was the fact that at least one of the child's parents was born in a country of high tuberculosis prevalence. Within the five strategies tested, two can be selected on the basis of their impact and efficiency: the testing of all children and the targeting of the testing to children with characteristics putting them at high risk of tuberculosis.

For Paris or other large cities in France, decision-makers will have to consider the local tuberculosis epidemiology, the resources that can be devoted to tuberculosis screening of schoolchildren and the regional specificities of the new BCG vaccination policy.