Tuberculosis Screening at 2 San Diego High Schools With High-Risk Populations

Pong, Alice; Anders, Bronwen; Moser, Kathleen; Starkey, Monica J.; Gaßmann, Almut; Besser, Richard E.

doi:10.1001/archpedi.152.7.646

Cited by 16 publications

(15 citation statements)

References 12 publications

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“…However, the proportion of children who were TST-positive in this study was similar to that found in other studies of school-based screening programs for immigrant children both in Canada [8][9][10] and other lowburden countries. 11,15 Similarly, the proportion of associates who were TST-positive in this study (38%) was comparable to that of the existing studies on household associates of infected schoolchildren, which had TST positivity ranging from 30% to 43%. [16][17][18][19] The activecase-finding rate in this study was somewhat lower than that found in 2 previous studies of school-based TBscreening programs that targeted high-risk populations 8,11 but was higher than that of another evaluated program in which no cases were found 10 and was slightly higher than that of a study of a screening program based in schools with mixed Canadian-born and foreign-born populations.…”

Section: Discussionsupporting

confidence: 81%

“…[16][17][18][19] The activecase-finding rate in this study was somewhat lower than that found in 2 previous studies of school-based TBscreening programs that targeted high-risk populations 8,11 but was higher than that of another evaluated program in which no cases were found 10 and was slightly higher than that of a study of a screening program based in schools with mixed Canadian-born and foreign-born populations. 15 It should be noted that the number of cases found in all of the studies mentioned above did not exceed 2, which may account for the variability in results.…”

Section: Discussionmentioning

confidence: 87%

“…7 To maintain TB-prevention programming among foreign-born children in a low-incidence area, it is necessary to assess the potential effectiveness of such a program in terms of successful screening, drug-therapy treatment, adherence to treatment, and cost-effectiveness. Furthermore, determining which factors are associated with adherence to treatment allows for an assessment of strengths and opportunities for improvement in a particular targeted screening program.Previous studies evaluating school-based screening studies [8][9][10][11][12][13][14][15] have not included any details of related associate investigations, nor have they determined factors associated with adherence to TB drug therapy. Of the few studies that have evaluated associate investigations in children, [16][17][18][19] only 1 included children Ͼ8 years of age, none were explicitly related to another targeted screening-program strategy, and none included a cost-benefit analysis.…”

mentioning

confidence: 99%

“…Previous studies evaluating school-based screening studies [8][9][10][11][12][13][14][15] have not included any details of related associate investigations, nor have they determined factors associated with adherence to TB drug therapy. Of the few studies that have evaluated associate investigations in children, [16][17][18][19] only 1 included children Ͼ8 years of age, none were explicitly related to another targeted screening-program strategy, and none included a cost-benefit analysis.…”

mentioning

confidence: 99%

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Evaluation of a School-Based Tuberculosis-Screening Program and Associate Investigation Targeting Recently Immigrated Children in a Low-Burden Country

et al. 2006

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CONTEXT. In countries with a low incidence of tuberculosis (TB), screening programs targeting recent immigrants from TB-endemic countries have been shown to be effective in further reducing TB incidence; however, evaluative data on some aspects of these programs remain sparse.OBJECTIVE. We sought to retrospectively evaluate a school-based screening program targeting children at high risk for TB infection in Montreal, Canada, as well as subsequently investigate family and household associates of the schoolchildren with latent TB infection (LTBI), based on adherence to LTBI therapy and costbenefit analysis.DESIGN, SETTING, AND PARTICIPANTS. Newly arrived immigrant children (aged 4 -18 years) in selected schools were screened for LTBI by using the tuberculin skin test (TST). The TST was defined as positive at an induration of Ն10 mm. Each child who tested positive on the TST was referred for medical evaluation. Family and household associates of the TST-positive child also were screened for LTBI. Classroom attendance sheets and medical charts were reviewed for 16 elementary and secondary schools that comprised the school-screening program of the Montreal Children's Hospital from 1998 to 2003. Medical charts of the child associates (Ͻ18 years old) who were screened were reviewed also.MAIN OUTCOME MEASURES. The main outcome measures were TST-positivity rate, rate of adherence to LTBI therapy, estimation of factors associated with adherence, and net cost/benefit of the school-screening and associate-investigation programs, both respectively and as a combined program, compared with the cost of passive treatment of TB disease.RESULTS. Of 2524 immigrant children screened, 542 (21%) were TST-positive. Of 342 children started on therapy, 316 (92%) demonstrated adequate adherence. The only predictor of adherence among the schoolchildren was having Ն2 family members brought in for TB screening (adjusted odds ratio: 2.0; 95% confidence interval: 1.3-3.3). There were 599 associates investigated from the 484 TST-positive schoolchildren seen at the TB clinic. Of 555 associates with TST results, 211 (38%) were found to be TST-positive. Of 136 TST-positive child associates, 131 were seen at the Montreal Children's Hospital TB clinic and had their chart reviewed. Of these, 108 (82%) were started on LTBI therapy, and 78 (79%) of 99 of those children with information complied adequately with their therapy. We found net benefits from both school-based screening and associate investigation, both as stand-alone programs and as 1 coordinated, targeted TB-screening program.CONCLUSION. We demonstrated the effectiveness, including cost-effectiveness, of a targeted, school-based screening program in a low-burden country and the extra benefit given by adding associates to such a program. IMMIGRANTS AND FOREIGN-BORN Canadians account for more than half of all active tuberculosis (TB) cases in Canada, 1 and in Montreal their overall risk for developing active disease is 10 times higher than the nonforeign-born population (37.5 and 3.3 c...

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 87%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of a School-Based Tuberculosis-Screening Program and Associate Investigation Targeting Recently Immigrated Children in a Low-Burden Country

et al. 2006

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“…37 School-based screening for LTBI is allowed under the state health and safety code in California. 38 Pong et al 39 demonstrated high rates of TST positivity among 1504 high school students in San Diego. Two high schools were studied, and positive TSTs were found in 13% (95 of 744) and 24% (207 of 860) of students.…”

Section: School-based Screening For Ltbimentioning

confidence: 99%

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

2004

Pediatrics

110

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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

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Other Diseases Caused by Bacteriae

Braga¹

2002

Nuclear Medicine in Tropical and Infectious Diseases

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Tuberculosis Screening at 2 San Diego High Schools With High-Risk Populations

Cited by 16 publications

References 12 publications

Evaluation of a School-Based Tuberculosis-Screening Program and Associate Investigation Targeting Recently Immigrated Children in a Low-Burden Country

Evaluation of a School-Based Tuberculosis-Screening Program and Associate Investigation Targeting Recently Immigrated Children in a Low-Burden Country

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

Other Diseases Caused by Bacteriae

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