Interferon-Gamma Release Assays and Pediatric Public Health Tuberculosis Screening: The San Francisco Program Experience 2005 to 2008

Details

• Alternative Title:
  J Pediatric Infect Dis Soc
• Personal Author:
  Grinsdale, Jennifer A. ; Islam, Shamim ; Tran, Olivia Chang ; Ho, Christine S. ; Kawamura, L. Masae ; Higashi, Julie M.
• Description:
  Background.
  
  Interferon-gamma release assay utilization in pediatric tuberculosis (TB) screening is limited by a paucity of longitudinal experience, particularly in low-TB burden populations.
  
  Methods.
  
  We conducted a retrospective review of QuantiFERON (QFT)-TB Gold results in San Francisco children from 2005 to 2008. Concordance with the tuberculin skin test (TST) was analyzed for a subset of children. Progression to active disease was determined through San Francisco and California TB registry matches.
  
  Results.
  
  Of 1092 children <15 years of age, 853 (78%) were foreign-born, and 136 (12%) were exposed to active TB cases (contacts). QuantiFERON tests were positive in 72 of 1092 (7%) children; 15 of 136 (11%) recent contacts; 53 of 807 (7%) foreign-born noncontacts; and 4 of 149 (3%) US-born noncontacts. QuantiFERON-negative/TST-positive discordance was seen more often in foreign-born/bacille Calmette-Guerin (BCG)-vaccinated children <5 years of age (52 of 56, 93%) compared to those ≥ 5 years of age (90 of 123, 73%; P = .003). Foreign-born, BCG-vaccinated children were more than twice as likely to have a discordant (79%) result as US-born, non-BCG-vaccinated children (37%; P < .0001). During 5587 person-years of follow-up of untreated children, including 146 TST-positive/QFT-negative children, no cases of active TB were identified, consistent with a negative predictive value of 100%.
  
  Conclusions.
  
  Our experience supports the use of QFT to evaluate latent TB infection in children, particularly young BCG-vaccinated children. The proportion of QFT-positive results correlated with risk of exposure, and none of the untreated QFT-negative children developed TB. The low QFT-positive rate highlights the need for more selective testing based on current epidemiology and TB exposure risk.
  
  
• Subjects:
  Adolescent Child Child, Preschool Female Humans Infant Interferon-gamma Release Tests Male Mass Screening Retrospective Studies San Francisco Tuberculin Test Tuberculosis

  More +
• Keywords:
  Interferon-gamma Release Assays Pediatrics Tuberculosis
• Source:
  J Pediatric Infect Dis Soc. 5(2):122-130
• Pubmed ID:
  27199468
• Pubmed Central ID:
  PMC9158372
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; U52 PS900454/PS/NCHHSTP CDC HHSUnited States/
• Volume:
  5
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:1b67996d7984e17f034c92b373fad3c0a8195615409331124a58fc9f252c8398d1f5e3a18786c15cbd344d79ad2bfc22d457df313f1de3986bd3ff5cd3d69e96
• Download URL:
  https://stacks.cdc.gov/view/cdc/119211/cdc_119211_DS1.pdf
• File Type:
  [PDF - 679.71 KB ]