Screening for tuberculosis infection in urban children

Area of Science:

• Pediatric Infectious Diseases
• Public Health
• Epidemiology

Background:

• Tuberculosis (TB) remains a significant global health concern, necessitating effective screening strategies in pediatric populations.
• The American Academy of Pediatrics (AAP) provides criteria for identifying children at high risk for TB, guiding screening recommendations.

Purpose of the Study:

• To assess the proportion of children meeting AAP-defined high-risk criteria for TB.
• To evaluate compliance rates for tuberculin skin test (TST) interpretation.
• To determine the prevalence of TB infection among children in an urban pediatric clinic.

Main Methods:

• A cross-sectional study was conducted on 401 children aged 12 months to 18 years at a hospital-based urban pediatric clinic.
• Participants completed a questionnaire, received an intradermal TST, and were scheduled for interpretation within 48-72 hours.
• Data collected included risk factors, TST results, and demographic information.

Main Results:

• 85% of children had at least one TB risk factor, with parental origin from high prevalence countries (42%) and low household income (67%) being common.
• 300 children (75%) returned for TST interpretation; 1.3% had a positive TST (induration ≥10 mm).
• Positive TST results were associated with having a parent from a high-prevalence country and were observed in older children.

Conclusions:

• AAP-defined criteria for high-risk children demonstrate high sensitivity but low positive predictive value due to low TB prevalence.
• While supporting targeted screening, the findings suggest annual TB testing may not be cost-effective in many US communities.
• The study highlights the importance of considering local epidemiology when implementing TB screening programs.