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Evaluating UK National Guidance for Screening of Children for Tuberculosis. A Prospective Multicenter Study

Beate Kampmann1,2, James A Seddon1, James Paton3

  • 11 Centre of International Child Health, Department of Academic Paediatrics, Imperial College London, London, United Kingdom.

American Journal of Respiratory and Critical Care Medicine
|December 1, 2017
PubMed

Insights

Tuberculosis (TB) infection treatment was not given to children who tested positive on the TST but negative on IGRA. No TB disease developed in these children, suggesting current guidelines may overtreat some cases.

Area of Science:

  • Pediatric infectious diseases
  • Immunology
  • Public health

Background:

  • UK National Institute for Health and Care Excellence (NICE) guidelines in 2006 recommended using Interferon-gamma Release Assays (IGRA) alongside the Tuberculin Skin Test (TST) for identifying tuberculosis (TB) contacts.
  • These guidelines also advised against treating TB infection in children who screened positive on TST but negative on IGRA.

Purpose of the Study:

  • To evaluate the risk of developing active TB disease in children who were TST-positive but IGRA-negative and did not receive TB infection treatment.
  • To compare the number of children qualifying for TB infection treatment under the 2006 NICE guidelines versus the revised 2016 NICE guidance.

Main Methods:

  • A cohort study involving 431 children exposed to infectious TB cases within their households, recruited from 11 pediatric TB clinics.
  • Baseline TST and IGRA were performed, with IGRA repeated at 8 weeks. TST was repeated if initially negative. Children received treatment based on 2006 NICE guidelines and were followed for 24 months.

Main Results:

  • Of 392 children who completed the study, 48 (12.2%) had prevalent TB disease, 105 (26.8%) had TB infection, and 239 (60.9%) had neither.
  • Eighteen children (aged ≥2 years) had TST-positive and persistently IGRA-negative results. None received treatment, and none developed TB disease.
  • Ninety children (26.1%) qualified for treatment under 2006 NICE guidelines, whereas 147 (42.7%) would qualify under the 2016 NICE guidance.

Conclusions:

  • In a low-prevalence setting, no incident TB disease occurred in children who were TST-positive, IGRA-negative, and untreated.
  • The revised 2016 NICE guidance would lead to a significantly higher number of children being recommended for TB infection treatment.
Abstract

Keywords:
IFN-γ release assayschildhood tuberculosisdiagnosis of tuberculosis infection

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