Targeted Tuberculin Skin Testing and Treatment of Latent Tuberculosis Infection in Children and Adolescents

Abstract

ABSTRACT.Comprehensive new guidelines for screening, targeted testing, and treating latent tuberculosis infection (LTBI) in children and adolescents are presented. The recent epidemiology of TB and data on risk factors for LTBI are reviewed. The evidence-based recommendations provided emphasize the paradigm that children and adolescents should be screened for risk factors by using a risk-factor questionnaire for TB and LTBI and tested with the tuberculin skin test only if >1 risk factor is present. The use of administrative or mandated tuberculin skin tests for entry to day care, school, or summer camp is strongly discouraged. Treatment regimens, suggestions to improve adherence, and methods to monitor toxicities are summarized. Children and adolescents with LTBI represent the future reservoir for cases of TB. Thus, detecting and treating LTBI in children and adolescents will contribute to the elimination of TB in the United

Tuberculosis in Internationally Displaced Children Resettling in Harris County, Texas, USA, 2010–20151

“…However, BCG immunization cannot explain the increased prevalence of positive IGRA results in these young children. Furthermore, these data contradict previous studies that demonstrate that older children are more likely to have TB infection (30)(31)(32)(33)(34). One possible explanation is that IGRA-positive children <2 years of age in our cohort had more prolonged exposure to an adult family member with infectious pulmonary TB in the home, because very young children spend more time in the home than their school-aged counterparts.…”

“…Children <2 years and >14 years of age had a higher prevalence of positive results for TST, IGRA, or both compared with children 2-14 years of age. Older children (>14 years of age) in our cohort had increased prevalence of positive TB test results by both the TST and IGRA, which more likely represented true TB infection because of the children's greater time outside the home and cumulative exposure to adults with infectious pulmonary TB (30)(31)(32)(33)(34). The higher frequency of positive tests in children <2 years of age, on the other hand, is more difficult to explain.…”

Treatment for Preventing Tuberculosis in Children and Adolescents

“…15 In the United States, some TB control departments use directly observed therapy for the administration of LTBI treatment to persons at highest risk of developing TB, including children, if sufficient resources are available. 16,17 Recently, the PREVENT TB (Three Months of Rifapentine and Isoniazid for Latent Tuberculosis Infection) 18 clinical trial demonstratedthat a short-course combination regimen of rifapentine and isoniazid for 3 months given with direct observation was as effective as the reference-standard 9-month regimen of self-administered isoniazid in persons 12 years or older; combination therapy with rifapentine and isoniazid was safe and had a higher treatment completion rate. However, too few children were enrolled for safety and effectiveness to be evaluated separately.…”

Multi-Level Barriers to LTBI Treatment: A Research Note

“…The most commonly recommended treatment for LTBI in the US is a 9 month course of isoniazid (INH), which is over 90% efficacious in preventing progression, even in individuals with variable compliance [8]. Treatment of children and adolescents is felt to be particularly important because of their increased risk of progression to active TB, expected greater number of years of risk, as well as the safety of treatment [8, 9]. …”