Screening Young Children for Latent Tuberculosis in England: Lessons Learned from the FieldFunding None.
09 January 2019
02 May 2019
04 June 2019 (eFirst)
Objective Tuberculosis (TB) can affect young children, resulting in serious disease at a young age or reactivation later in life. Identifying cases of latent TB infection (LTBI) in children exposed to active cases is important to prevent morbidity and mortality. There is currently limited guidance on appropriate testing methods in situations involving mass screening of children in low TB incidence settings such as England. This study describes case reports of two separate occasions in which nursery-age children in England underwent LTBI screening and explores the decisions involved in choosing the most appropriate test and screening process.
Methods A literature search, review of health protection case and incident management notes, and interviews with key stakeholders were conducted.
Results Two different tests—tuberculin skin testing and interferon gamma release assay—were used in each respective screening situation and the decision between the two was taken based on cohort, organizational, and index case risk factors. Screening took place in dedicated secondary care clinics. No cases of LTBI were identified from either screening incident.
Conclusion Our study highlights the lack of definitive guidance for mass LTBI screening of young children and presents the approaches to decision making that can be adopted by others. Further research is required to test the approach suggested in this article and to ensure that evidence-based national guidance provides a consistent and effective approach to such incidents.
- 1 National Institute for Health and Care Excellence. Tuberculosis [NG33]. London, UK: National Institute for Health and Care Excellence; 2016
- 2 Pubic Health England. Latent TB Testing and Treatment for Migrants, a Practical Guide for Commissioners and Practitioners. London, UK: Public Health England; 2015
- 3 Public Health England. TB Case Notifications and Rates by Age Group and Place. London UK: Public Health England; 2017
- 4 Public Health England. Public Health Profiles. Available at: https://fingertips.phe.org.uk/ . Accessed April 9, 2018
- 5 Public Health England. Enhanced Tuberculosis Surveillance (ETS) Report. London, UK: Public Health England; 2018
- 6 Nayak S, Acharjya B. Mantoux test and its interpretation. Indian Dermatol Online J 2012; 3 (01) 2-6
- 7 Public Health England. Position statement on the use of interferon gamma release assay tests for tuberculosis. London, UK: Public Health England; 2013
- 8 Parmar MS. A false-positive tuberculin test result. CMAJ 2000; 162 (01) 19
- 9 Seddon JA, Paton J, Nademi Z. , et al. The impact of BCG vaccination on tuberculin skin test responses in children is age dependent: evidence to be considered when screening children for tuberculosis infection. Thorax 2016; 71 (10) 932-939
- 10 Newton SM, Brent AJ, Anderson S, Whittaker E, Kampmann B. Paediatric tuberculosis. Lancet Infect Dis 2008; 8 (08) 498-510
- 11 Veen J. Microepidemics of tuberculosis: the stone-in-the-pond principle. Tuber Lung Dis 1992; 73 (02) 73-76
- 12 Public Health England. Tuberculosis. The Green Book. London, UK: Public Health England; 2013
- 13 Oxford Immunotec. T-Spot.TB. Available at: http://www.tspot.com . Accessed January 30, 2018
- 14 Quest Diagnostics. QuantiFERON-TB Gold In-Tube Test. Quest Diagnostics. Available at: https://www.questdiagnostics.com/home/physicians/testing-services/by-test-name/quantiferon . Accessed January 30, 2018
- 15 Machingaidze S, Wiysonge CS, Gonzalez-Angulo Y. , et al. The utility of an interferon gamma release assay for diagnosis of latent tuberculosis infection and disease in children: a systematic review and meta-analysis. Pediatr Infect Dis J 2011; 30 (08) 694-700
- 16 Auguste P, Tsertsvadze A, Pink J. , et al. Accurate diagnosis of latent tuberculosis in children, people who are immunocompromised or at risk from immunosuppression and recent arrivals from countries with a high incidence of tuberculosis: systematic review and economic evaluation. Health Technol Assess 2016; 20 (38) 1-678
- 17 Ge L, Ma JC, Han M, Li JL, Tian JH. Interferon-γ release assay for the diagnosis of latent Mycobacterium tuberculosis infection in children younger than 5 years: a meta-analysis. Clin Pediatr (Phila) 2014; 53 (13) 1255-1263