Directive and guidance documents on the use of skin immunological tests for screening tuberculosis infection in children and adolescents: phthisiologist's review and comments

Abstract

Skin immunological tests are the main method for detecting tuberculosis infection in children and adolescents. A Mantoux test with two tuberculin units (TU) PPD-L has been one of the most effective methods for detecting tuberculosis in the pediatric group over a period of many decades. The development of a new test - a recombinant TB allergen diagnostic test - has changed approaches to screening for tuberculosis infection in children. Today, both tests are used but with differentiation according to the age category of children (Mantoux test - from 1 year to 7 years, recombinant tuberculosis allergen - from 8 to 17 years). This approach was enshrined in the current directive and guidance documents in 2014. However, there is no single document that could serve as a desk book on this issue for a paediatric practitioner. Moreover, the article presents one of the most difficult issues that require knowledge of the relevant legislation and ability to conduct health education work on the part of the practitioners - the legal aspects of tuberculosis immunodiagnosis in children and adolescents in case of refusal of skin immunological testing. The low health and sanitary literacy regarding tuberculosis and its prevention in the population can also be viewed as a result of the use of mass media on the issue by non-professionals. It should be noted that some of the documents are published on the website of the Russian Society of Phthisiologists as guidance manuals and clinical recommendations, which are overlooked by practitioners of general medical institutions. The summation of directive and guidance documents on all issues of the use of skin immunological tests with comments is aimed at enhancing knowledge and, accordingly, the effectiveness of their use.