Evaluating a 24‐year tuberculosis screening in first‐grade elementary schoolers in a low‐burden area

Abstract

Aim: Early diagnosis of tuberculosis infection can significantly contribute to the control of the disease. The aim of the present study was to describe the tuberculin skin test (TST) trends over a 24-year period (1990-2013) and explore the value of universal tuberculosis screening in a low-burden area.Methods: All first graders that underwent TST during the 24-year study period on the island of Crete, Greece, were retrospectively included in the study.Results: A total of 82 402 children (92.3% of Greek nationality; 51.0% male) underwent TST, of whom 335 (0.41%, 95% CI 0.37-0.46) were found to have positive TST while 0.27% of the study population had a TST between 5 and 9 mm. The tuberculin index declined significantly between 1990-1994 and 2010-2013 (0.67 vs 0.26; RR 2.73, 95% CI 1.82-4.09; p < 0.0001). Positive TST result was significantly higher in the immigrant than the native group (0.66% vs 0.24%; RR 3.76 95%, CI 2.89-4.84; p < 0.0001). In the last study years, 386 children (488 native; 153 immigrant) should be tested for one to be found TST positive.Conclusion: Our findings question the massive tuberculin testing in low-burden areas and point to selective screening of high-risk groups.

Adherence to Recommendations for Βacillus Calmette-Guérin Vaccination of High-risk Neonates in Greece

“…Switch from a universal BCG vaccination policy for 6-yearold children at school entry to a targeted vaccination policy for high-risk neonates at birth was necessary due to a reduction in pediatric TB incidence during the past 2 decades. [5][6][7][8] Change in policy was in accordance with the International Union against Tuberculosis and Lung Disease criteria for discontinuation of universal BCG vaccination programs in countries with low TB prevalence. 10 The newly-adopted BCG vaccination policy at birth offers an ideal opportunity to surpass barriers related to the accessibility of vaccination services.…”

“…However, the incidence of TB in children in Greece decreased significantly over the past 2 decades, while immigrant children comprised an increasing proportion of diagnosed cases, including MDR-TB cases. [5][6][7][8] A hospital-based retrospective study in Athens, Greece of all (321) children <14 years with active TB diagnosed during 2000-2009 revealed that one-third of them originated from highly endemic countries. 5 In addition, immigrant children accounted for 61% of extra-pulmonary TB cases and for most MDR-TB cases.…”