Systematic screening for active tuberculosis: principles and recommendations.

Systematic screening for active tuberculosis: principles and recommendations.

World Health Organization (WHO). Systematic screening for active tuberculosis: principles and recommendations. Geneva (Switzerland): World Health Organization (WHO); 2013. 133 p. [103 references] Major Recommendations The rating schemes for the quality of the evidence (high, moderate, low, very low) and the strength of the recommendations (strong, conditional) are defined at the end of the "Major Recommendations" field. Key Principles for Screening for Active Tuberculosis (TB) The following key principles should be considered when planning a TB screening initiative. Before screening is initiated, high-quality TB diagnosis, treatment, care, management and support for patients should be in place, and there should be the capacity to scale these up further to match the anticipated rise in case detection that may occur as a result of screening. In addition, a baseline analysis should be completed in order to demonstrate that the potential benefits of screening clearly outweigh the risks of doing harm, and that the required investments in screening are reasonable in relation to the expected benefits. Indiscriminate mass screening should be avoided. The prioritization of risk groups for screening should be based on assessments made for each risk group of the potential benefits and harms, the feasibility of the initiative, the acceptability of the approach, the number needed to screen, and the cost effectiveness of screening. The choice of algorithm for screening and diagnosis should be based on an assessment of the accuracy of the algorithm for each risk group considered, as well as the availability, feasibility and cost of the tests. TB screening should follow established ethical principles for screening for infectious diseases, observe human rights, and be designed to minimize the risk of discomfort, pain, stigma and discrimination. The TB screening approach should be developed and implemented in a way that optimizes synergies with the delivery of other health services and social services. A screening strategy should be monitored and reassessed continually to inform re-prioritization of risk groups, re-adaptation of screening approaches when necessary and discontinuation of screening at an appropriate time. See section 7 in the original guideline document for details on the key principles. Recommendations on Risk Groups to Be Screened for Active TB ....

Comparison of tuberculin skin test and QuantiFERON®-TB gold in-tube for the diagnosis of childhood tuberculosis infection

Comparison of tuberculin skin test and QuantiFERON®-TB gold in-tube for the diagnosis of childhood tuberculosis infection

Selda Hancerli Torun, Ozan Uzunhan, Ayper Somer, Nuran Salman and Kaya Köksalan
Accepted manuscript online: 22 APR 2015 09:02AM EST | DOI: 10.1111/ped.12659

Pediatrics International Aim Tuberculosis (TB) is an important worldwide ongoing health issue. To be able to control tuberculosis, one should not only cure active tuberculosis cases but also detect childhood tuberculosis infection patients who have the possibility of developing active disease in the future. Our aim in this study is to compare a century-old tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube (QFT-GIT) test which was developed as an alternative to TST and claimed to be superior to TST in several ways for diagnosis of TB in childhood. Materials and Methods Fifty three children with TB disease between 5 months and 17.5 years of age and 92 healthy children from the same age group with no risk factors for tuberculosis infection were recruited into the study. All children were performed TST and QFT-GIT test and their demographic, clinic and laboratory data were recorded. Data was analyzed by using SPSS 14. Results 53 patients were diagnosed TB. The mean of age distribution of the patients was 8.5±4.3 years (ranged from 5 months-17.5 years). 41.7 % of the patients were females. 16 of 53 patients were confirmed by culture. QFT-GIT test was positive in 16 and TST was positive in 15 among 16 culture-confirmed TB disease children. The sensitivity of TST and QFT-GIT could be estimated 93.8% and 100.0%, and the specificity of TST and QFT-GIT could be estimated 100.0% and 97.8%, respectively. When the results of QFT-GIT and TST were compared among 53 TB disease children including cases without bacteriologically confirmation, QFT-GIT was positive in 33 children, and TST was positive in 44 children. The sensitivity of TST and QFT-GIT could be estimated 83.0% and 62.3%, and the specificity of TST and QFT-GIT could be estimated 100.0% and 97.8%, respectively. Conclusion Although positive QFT-GIT test result is very significant for TB, negative results will not exclude TB infection. TST and QFT-GIT are used together may provide more efficient results. This article is protected by copyright. All rights reserved.

Missed Opportunities for Tuberculosis Screening in Primary Care.

J Pediatr. 2015 Feb 23. pii: S0022-3476(15)00084-0. doi:10.1016/j.jpeds.2015.01.037. [Epub ahead of print]
van der Heijden YF, Heerman WJ, McFadden S, Zhu Y, Patterson BL.

OBJECTIVE: 

To assess how frequently pediatric practitioners perform latent tuberculosis infection (LTBI) screening according to guidelines. We hypothesized that screening occurs less frequently among children whose parents do not speak English as the primary language.

STUDY DESIGN: 

We conducted a retrospective cohort study of patients attending well-child visits in an urban academic pediatric primary care clinic between April 1, 2012, and March 31, 2013. We assessed documentation of 3 LTBI screening identified as at high risk for LTBI. Of these, 514 (62%) did not have documented tuberculin skin test (TST) placement and documentation of results.
RESULTS: 

During the study period, 387 of 9143 children (4%) had no documentation of screening question responses. Among the other 8756 children, 831 (10%) were documentation of results, but non-Hispanic Black children were more likely to not TST placement in the appropriate time frame. Thirty-nine of 213 children (18%) who had a TST placed did not have documented results. Multivariable regression showed that parent language was not associated with TST placement or have a documented test result (aOR, 2.12; 95% CI, 1.07-4.19; P = .03) when results among high-risk children, the latter of which was associated with adjusting for age, sex, parent primary language, insurance status, day of the week, and study year of TST placement.
CONCLUSION: 

Parent primary language was not associated with LTBI testing. However, we found substantial gaps in TST placement and documentation of TST race/ethnicity. Targeted quality improvement efforts should focus on developing processes to ensure complete screening in high-risk children.