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Evaluating UK national guidance for screening of children for tuberculosis a prospective multicenter study

Lookup NU author(s): Dr Zohreh Nademi

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Abstract

Copyright 2018 by the American Thoracic Society. Rationale: To identify infected contacts of tuberculosis (TB) cases, the UK National Institute for Health and Care Excellence (NICE) recommended the addition of IFN-g release assays (IGRA) to the tuberculin skin test (TST) in its 2006 TB guidelines. Treatment for TB infection was no longer recommended for children who screened TST-positive but IGRA-negative. Objectives: We performed a cohort study to evaluate the risk of TB disease in this group. Methods: Children exposed to an infectious case of TB in their household were recruited from 11 pediatric TB clinics. TST and IGRA were performed at baseline, with IGRA repeated at 8 weeks and TST repeated if initially negative. Children were treated according to 2006 NICE guidelines and followed for 24 months. Measurements and Main Results: Of 431 recruited children, 392 completed the study. We diagnosed 48 (12.2%) cases of prevalent TB disease, 105 (26.8%) with TB infection, and 239 (60.9%) without TB infection or disease. Eighteen children aged 2 years and above had a positive TST but persistently negative IGRA. None received TB infection treatment and none developed TB disease. Ninety (26.1%) children qualified for TB infection treatment according to 2006 NICE guidelines. In contrast, 147 (42.7%) children would have qualified under revised NICE guidance, issued in 2016. Conclusions: In this low-prevalence setting we saw no incident cases of TB disease in children who were TST-positive but IGRA-negative and did not receive treatment for TB infection. Following the latest NICE guidance, significantly more children will require medication.

Publication metadata

Author(s): Kampmann B, Seddon JA, Paton J, Nademi Z, Keane D, Williams B, Williams A, Liebeschutz S, Riddell A, Bernatoniene J, Patel S, Martinez N, McMaster P, Basu-Roy R, Welch SB

Publication type: Article

Publication status: Published

Journal: American Journal of Respiratory and Critical Care Medicine

Year: 2018

Volume: 197

Issue: 8

Pages: 1058-1064

Print publication date: 15/04/2018

Acceptance date: 30/11/2017

ISSN (print): 1073-449X

ISSN (electronic): 1535-4970

Publisher: American Thoracic Society

URL: https://doi.org/10.1164/rccm.201707-1487OC

DOI: 10.1164/rccm.201707-1487OC

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