Risk of Active Tuberculosis Among Schoolchildren in Hong Kong

Leung, Chi Chiu; Yew, Wing Wai; Chang, Kwok Chiu; Tam, Cheuk Ming; Chan, Chi Kuen; Law, Wing Sze; Wong, M; Lee, Shuk Nor; Leung, Maria

doi:10.1001/archpedi.160.3.247

Cited by 22 publications

(17 citation statements)

References 18 publications

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“…However, there are many data underlying our assessment of the positive predictive value of the TST for the risk of development of active tuberculosis, 33–35 and moreover, the TST has been used to define LTBI in studies that show the benefits of LTBI treatment. 15,36 The critical question is whether LTBI, if not detected by an IGRA, could still reactivate, especially in patients with immunosuppression and other medical risk factors.…”

Section: Discussionmentioning

confidence: 99%

Discordant QuantiFERON-TB Gold Test Results Among US Healthcare Workers With Increased Risk of Latent Tuberculosis Infection: A Problem or Solution?

Pollock

Campos-Neto²,

Kashino³

et al. 2008

Infect. Control Hosp. Epidemiol.

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OBJECTIVE In late 2006, our hospital implemented use of the QuantiFERON-TB Gold (QFT-G) assay, a whole-blood interferon-γ release assay, for detection of tuberculosis infection. All newly hired healthcare workers (HCWs) with positive Mantoux tuberculin skin test (TST) results were routinely tested with the QFT-G assay, to take advantage of its higher specificity. We then undertook a quality assurance review to evaluate the QFT-G test results in HCWs with multiple risk factors for latent tuberculosis infection (LTBI). METHODS The clinical records for TST-positive HCWs tested with the QFT-G assay were reviewed. HCWs with 2 or more risk factors commonly associated with LTBI were classified as “increased risk” (IR). IR HCWs who had negative QFT-G test results underwent repeat QFT-G testing and were offered testing with a different interferon-γ release assay (T-SPOT.TB) and with extended T cell stimulation assays. RESULTS Of 143 TST-positive HCWs tested with the QFT-G assay, 26 (18%) had positive results, 115 (81%) had negative results, and 2 (1%) had indeterminate results. Of 82 IR HCWs, 23 (28%) had positive QFT-G test results, and 57 (70%) had negative results. Of the 57 IR HCWs with negative results, 43 underwent repeat QFT-G testing: 41 had negative results again, and 2 had positive results. These 43 HCWs were also offered additional testing with the T-SPOT.TB diagnostic, and 36 consented: 31/36 tested negative, and 5/36 tested positive. Extended assays using the antigens ESAT-6 and CFP-10 confirmed the positive results detected by the overnight assays and yielded positive results for an additional 7/36 (19%) of individuals; strikingly, all 36 HCWs had strongly positive test results with assays using purified protein derivative. CONCLUSIONS The extreme discordance between the results of our clinical diagnostic algorithm and the results of QFT-G testing raises concern about the sensitivity of the QFT-G assay for detection of LTBI in our HCWs. Results of extended stimulation assays suggest that many of our IR HCWs have indeed been sensitized to Mycobacterium tuberculosis. It is possible that the QFT-G assay identifies those at higher reactivation risk rather than all previously infected, but, in the absence of long-term follow-up data, we should interpret negative QFT-G results with some caution.

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Section: Discussionmentioning

confidence: 99%

Discordant QuantiFERON-TB Gold Test Results Among US Healthcare Workers With Increased Risk of Latent Tuberculosis Infection: A Problem or Solution?

Pollock

Campos-Neto²,

Kashino³

et al. 2008

Infect. Control Hosp. Epidemiol.

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“…57 Our minimal estimate for this parameter comes from a Hong Kong cohort. 64 An alternative figure of 55.7 cases per 100 000 annually without discounting was found in 1924 to 1934 in Massachusetts. 58 …”

Section: Appendix: Choice Of Baseline Values For Model Input Estimationmentioning

confidence: 99%

Cost-effectiveness of Alternative Strategies for Tuberculosis Screening Before Kindergarten Entry

Flaherman

Porco

Marseille³

et al. 2007

Pediatrics

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The cost to prevent a case of tuberculosis by using either universal screening or targeted testing of kindergarteners is high. If targeted testing replaced universal tuberculin skin testing in California, then $1.27 million savings per year would be generated for more cost-effective strategies to prevent tuberculosis. Improving the positive predictive value of the risk factor tool or applying it to groups with higher prevalence of latent tuberculosis would make its use more cost-effective. Universal tuberculin skin testing should be discontinued, and targeted testing should be considered only when the prevalence of risk factor positivity and the prevalence of tuberculin skin testing positivity among risk factor-positive individuals are high enough to meet acceptable thresholds for cost-effectiveness.

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“…Children from birth to the age of 14 years have a lower risk of developing active TB compared to those at other ages. In 2001, the TB notification rates were 5.4, 3.5, 13.5, and 52.5 per 100 000 for those aged "0 to 4", "5 to 9", "10 to 14", and "15 to 19 years", respectively 6 .…”

Section: Introductionmentioning

confidence: 99%

What cannot be measured cannot be done; risk factors for childhood tuberculosis: a case control study

Karim

Rahman

Mamun

et al. 2012

Bangladesh Med Res Counc Bull

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Childhood tuberculosis is one of the major causes of childhood mortality and morbidity though much neglected within our National Tuberculosis Control Program. This case control study was carried out to identify the risk factors for tuberculosis among children. Cases (n=95) and controls (n=94) were selected from Directly Observed Treatment Short Course (DOTS) centers of four upazillas of Dhaka and Gazipur districts. Cases were childhood tuberculosis patient, who were test positive by sputum microscopy from January to May, 2011 and controls were children who visited DOTS laboratory suspecting tuberculosis infection but were sputum negative. Both cases and controls were selected from the sputum examination registers and were traced at home for exposure data. The study showed more girls were infected than boys. Several socio demographic and environmental factors were found to be associated with the development of childhood tuberculosis. Logistic regression model was constructed to find out the important predictors which revealed age, education of the respondents, indoor environment and contact pattern were significantly associated with childhood tuberculosis. Children more than 14 years of age had 6.25 times higher risk of developing childhood tuberculosis; (Odds ratio=6.25; 95% CI for OR=2.00 to 19.55), Children completed primary education had 3.12 times lower risk of developing childhood tuberculosis, (Odds ratio=.32; 95% CI for OR=.10 to 1.00). Those who resided in better in-house environment had 4.35 times lower risk of developing childhood tuberculosis (Odds ratio=.23; 95% CI for OR=.06 to .95) and children came in contact with source tuberculosis cases who were their relatives or neighbors were 5.26 times lower risk of developing childhood tuberculosis than being in contact with family members with TB (Odds ratio=.19; 95% CI for OR=.07 to .49). Contact Screening should be incorporated in National TB program for early detection and effective treatment of tuberculosis. Improvement of indoor environment and ventilation status of the bedroom might reduce the risk of developing childhood tuberculosis.

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Risk of Active Tuberculosis Among Schoolchildren in Hong Kong

Abstract: It is desirable to reexamine the existing screening method for BCG-vaccinated children from high-prevalence countries.

Cited by 22 publications

References 18 publications

Discordant QuantiFERON-TB Gold Test Results Among US Healthcare Workers With Increased Risk of Latent Tuberculosis Infection: A Problem or Solution?

Discordant QuantiFERON-TB Gold Test Results Among US Healthcare Workers With Increased Risk of Latent Tuberculosis Infection: A Problem or Solution?

Cost-effectiveness of Alternative Strategies for Tuberculosis Screening Before Kindergarten Entry

What cannot be measured cannot be done; risk factors for childhood tuberculosis: a case control study

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