Beate Kampmann1,2, James A Seddon1, James Paton3, Zohreh Nademi4,5, Denis Keane1, Bhanu Williams6, Amanda Williams6, Sue Liebeschutz7, Anna Riddell8, Jolanta Bernatoniene9, Sanjay Patel10, Nuria Martinez11, Paddy McMaster12, Robindra Basu-Roy1, Steven B Welch13. 1. 1 Centre of International Child Health, Department of Academic Paediatrics, Imperial College London, London, United Kingdom. 2. 2 Vaccines & Immunity Theme, Medical Research Council Unit The Gambia, Fajara, Gambia. 3. 3 School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, United Kingdom. 4. 4 Department of Paediatrics, Great North Children Hospital, Newcastle upon Tyne, United Kingdom. 5. 5 Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom. 6. 6 Department of Paediatrics, London North West Healthcare National Health Service Trust, Northwick Park Hospital, Middlesex, United Kingdom. 7. 7 Department of Paediatrics, Newham University Hospital, and. 8. 8 The Children's Hospital at the Royal London Hospital, Barts Health National Health Service Trust, London, United Kingdom. 9. 9 Department of Paediatric Infectious Diseases, Bristol Royal Hospital for Children, Paul O'Gorman Building, Bristol, United Kingdom. 10. 10 Department of Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, United Kingdom. 11. 11 Department of Paediatric Infectious Diseases, Evelina Children's Hospital, London, United Kingdom. 12. 12 Department of Paediatric Infectious Diseases, North Manchester General Hospital, Manchester, United Kingdom; and. 13. 13 Birmingham Chest Clinic, Heart of England National Health Service Foundation Trust, West Midlands, United Kingdom.
Abstract
RATIONALE: To identify infected contacts of tuberculosis (TB) cases, the UK National Institute for Health and Care Excellence (NICE) recommended the addition of IFN-γ 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.
RATIONALE: To identify infected contacts of tuberculosis (TB) cases, the UK National Institute for Health and Care Excellence (NICE) recommended the addition of IFN-γ 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.
Entities:
Keywords:
IFN-γ release assays; childhood tuberculosis; diagnosis of tuberculosis infection
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