• Beate Kampmann, James A Seddon, James Paton, Zohreh Nademi, Denis Keane, Bhanu Williams, Amanda Williams, Sue Liebeschutz, Anna Riddell, Jolanta Bernatoniene, Sanjay Patel, Nuria Martinez, Paddy McMaster, Robindra Basu-Roy, and Steven B Welch.
• 1 Centre of International Child Health, Department of Academic Paediatrics, Imperial College London, London, United Kingdom.
• Am. J. Respir. Crit. Care Med. 2018 Apr 15; 197 (8): 1058-1064.

RationaleTo 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.ObjectivesWe performed a cohort study to evaluate the risk of TB disease in this group.MethodsChildren 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 ResultsOf 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.ConclusionsIn 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.

26 keywords...

hide…