Abstract
US guidelines have recommended testing children emigrating from high tuberculosis-incidence countries with interferon-gamma release assays (IGRAs) or tuberculin skin tests (TSTs). We describe the Harris County (Texas) Public Health Refugee Health Screening Program's testing results during 2010-2015 for children <18 years of age: 5,990 were evaluated, and 5,870 (98%) were tested. Overall, 364 (6.2%) children had >1 positive test: 143/1,842 (7.8%) were tested with TST alone, 129/3,730 (3.5%) with IGRA alone, and 92/298 (30.9%) with both TST and IGRA. Region of origin and younger age were associated with positive TST or IGRA results. All children were more likely to have positive results for TST than for IGRA (OR 2.92, 95% CI 2.37-3.59). Discordant test results were common (20%) and most often were TST+/IGRA- (95.0%), likely because of bacillus Calmette-Guérin vaccination. Finding fewer false positives supports the 2018 change in US immigration guidelines that recommends using IGRAs for recently immigrated children.
References
Jun 26, 1998·Archives of Pediatrics & Adolescent Medicine·E B HayesC A McCarthy
Oct 31, 2001·American Journal of Public Health·P L GeltmanA F Meyers
Apr 3, 2003·Pediatrics·Celine R GounderSonal S Munsiff
Jun 3, 2005·Pediatrics·Janine Young, Mary E O'Connor
Aug 26, 2009·Journal of Paediatrics and Child Health·Mohamud SheikhAlison Howell
Dec 31, 2009·PloS One·Richard N van Zyl-SmitMadhukar Pai
May 4, 2010·Thorax·Michaela LucasMartyn French
Dec 23, 2011·The Pediatric Infectious Disease Journal·Kara GrayDavid Isaacs
Aug 6, 2014·The Pediatric Infectious Disease Journal·Meredith M HowleyUNKNOWN Tuberculosis Epidemiologic Studies Consortium
Aug 12, 2014·The Lancet Global Health·Peter J DoddJames A Seddon
Sep 14, 2015·Journal of Immigrant and Minority Health·Eboni M TaylorSharmila Shetty
Sep 27, 2015·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Stephen M GrahamHeather J Zar
Jun 24, 2016·Thorax·James A SeddonBeate Kampmann
Dec 10, 2016·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·David M LewinsohnGail L Woods