Interferon-Gamma Release Assay-Based Screening for Pediatric Latent Tuberculosis Infection in an Urban Primary Care Network - 23/08/18
, Bryn Gonzales, MD 1, Robert Belknap, MD 2, 5, Michael L. Wilson, MD 6, 7, Mary E. O'Connor, MD, MPH 8, 9, 10Abstract |
Objective |
To assess outcomes from a QuantiFERON-tuberculosis (TB) Gold (QFT)-based screening for pediatric latent TB infection (LTBI) in the Denver Health Community Health System (CHS), an urban primary-care network in the US.
Study design |
We retrospectively analyzed all QFTs (n = 6685) performed on children aged 2-18 years between January 5, 2011, and August 18, 2014. Risk factors for positive testing in the CHS population were identified by logistic regression, and further assessed using a case-control comparison. Results from CHS were compared with higher-TB-risk populations (refugee and TB clinics) in our health system.
Results |
Positive QFT occurred in 79 of 3745 (2.1%) CHS patients. Positive rates increased with age (0.3% in age 2-5 years to 4.9% in age 13-18 years). Indeterminate results were uncommon (0.8%) including in children <5 (1.3%). Risk factors for positive tests in the CHS population included non-Medicaid insured/uninsured and non-English/Spanish preferred language. In the case-control analysis, birth/travel to/residence in a TB-endemic country was the only identified risk factor for positive testing (OR 5.2 [95% CI 1.04-25.5]). Rates of positive testing were lower in the CHS population than the refugee/TB clinic populations, including among children age 2-5.
Discussion |
QFT-based LTBI screening was successfully introduced in our pediatric primary-care health system, and supported our programmatic goals of identifying LTBI cases while limiting unnecessary LTBI treatment courses. Increasing positive rates with age, and higher rates in the refugee/TB populations compared with CHS, add indirect evidence of adequate test sensitivity, even among young children, for whom data on interferon-gamma release assay performance are limited.
Le texte complet de cet article est disponible en PDF.Keywords : tuberculosis infection, pediatrics, screening, interferon gamma release assay
Abbreviations : ATS, BCG, CHS, IGRA, LTBI, QFT, TB, TST
Plan
| The authors declare no conflicts of interest. |
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| Portions of this study were presented as posters at the Union Against Tuberculosis (TB) and Lung Disease, North American Region/National TB Controllers Association Annual Conference, February 24-27, 2016, Denver, Colorado and the Union Against TB and Lung Disease North American Region Annual Conference, February 22-25, 2017, Vancouver, British Colombia, Canada. |
Vol 200
P. 202-209 - septembre 2018 Retour au numéro
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