US Postarrival Evaluation of Immigrant and Refugee Children with Latent Tuberculosis Infection Diagnosed Overseas, 2007–2019

Details

• Alternative Title:
  J Pediatr
• Personal Author:
  Wang, Zanju ; Posey, Drew L. ; Brostrom, Richard J. ; Morris, Sapna Bamrah ; Marano, Nina ; Phares, Christina R.
• Description:
  Objective
  
  To assess outcomes from the US postarrival evaluation of newly arrived immigrant and refugee children aged 2–14 years who were diagnosed with latent tuberculosis infection (LTBI) during a required overseas medical examination.
  
  Study design
  
  We compared overseas and US interferon-γ release assay (IGRA)/tuberculin skin test (TST) results and LTBI diagnosis; assessed postarrival LTBI treatment initiation and completion; and evaluated the impact of switching from TST to IGRA to detect Mycobacterium tuberculosis infection overseas.
  
  Results
  
  In total, 73 014 children were diagnosed with LTBI overseas and arrived in the US during 2007–2019. In the US, 45 939 (62.9%) completed, and 1985 (2.7%) initiated but did not complete a postarrival evaluation. Among these 47 924 children, 30 360 (63.4%) were retested for M tuberculosis infection. For 17 996 children with a positive overseas TST, 73.8% were negative when retested by IGRA. For 1051 children with a positive overseas IGRA, 58.0% were negative when retested by IGRA. Overall, among children who completed a postarrival evaluation, 18 544 (40.4%) were evaluated as having no evidence of TB infection, and 25 919 (56.4%) had their overseas LTBI diagnosis confirmed. Among the latter, 17 229 (66.5%) initiated and 9185 (35.4%) completed LTBI treatment.
  
  Conclusions
  
  Requiring IGRA testing overseas could more effectively identify children who will benefit from LTBI treatment. However, IGRA reversions may occur, highlighting the need for individualized assessment for risk of infection, progression, and poor outcome when making diagnostic and treatment decisions. Strategies are needed to increase the proportions receiving a postarrival evaluation and completing LTBI treatment.
  
  
• Subjects:
  Child Emigrants And Immigrants Humans Interferon-gamma Release Tests Latent Tuberculosis Refugees Tuberculin Test Tuberculosis
• Source:
  J Pediatr. 245:149-157.e1
• Pubmed ID:
  35120982
• Pubmed Central ID:
  PMC9306290
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  245
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:2608df325fb8153158f61da649435846d390b1c9c1b239fccc1c1f90f9200a7a
• Download URL:
  https://stacks.cdc.gov/view/cdc/119637/cdc_119637_DS1.pdf
• File Type:
  [PDF - 816.41 KB ]