Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO; Denver Metro Tuberculosis Clinic, Denver Public Health, Denver, CO; Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO; Department of Epidemiology, Colorado School of Public Health; Aurora, CO.
Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO.
J Pediatr. 2018 Sep;200:202-209. doi: 10.1016/j.jpeds.2018.04.034. Epub 2018 Jun 1.
To assess outcomes from a QuantiFERON-tuberculosis (TB) Gold (QFT)-based screening for pediatric latent TB infection (LTBI) in the Denver Health Community Health System (CHS), an urban primary-care network in the US.
We retrospectively analyzed all QFTs (n = 6685) performed on children aged 2-18 years between January 5, 2011, and August 18, 2014. Risk factors for positive testing in the CHS population were identified by logistic regression, and further assessed using a case-control comparison. Results from CHS were compared with higher-TB-risk populations (refugee and TB clinics) in our health system.
Positive QFT occurred in 79 of 3745 (2.1%) CHS patients. Positive rates increased with age (0.3% in age 2-5 years to 4.9% in age 13-18 years). Indeterminate results were uncommon (0.8%) including in children <5 (1.3%). Risk factors for positive tests in the CHS population included non-Medicaid insured/uninsured and non-English/Spanish preferred language. In the case-control analysis, birth/travel to/residence in a TB-endemic country was the only identified risk factor for positive testing (OR 5.2 [95% CI 1.04-25.5]). Rates of positive testing were lower in the CHS population than the refugee/TB clinic populations, including among children age 2-5.
QFT-based LTBI screening was successfully introduced in our pediatric primary-care health system, and supported our programmatic goals of identifying LTBI cases while limiting unnecessary LTBI treatment courses. Increasing positive rates with age, and higher rates in the refugee/TB populations compared with CHS, add indirect evidence of adequate test sensitivity, even among young children, for whom data on interferon-gamma release assay performance are limited.
评估美国丹佛健康社区卫生系统（CHS）中基于 Quantiferon-结核（TB）金（QFT）的儿童潜伏性 TB 感染（LTBI）筛查的结果，该系统是一个城市初级保健网络。
我们回顾性分析了 2011 年 1 月 5 日至 2014 年 8 月 18 日期间，年龄在 2-18 岁之间的所有 6685 例 QFT。通过逻辑回归确定 CHS 人群中阳性检测的危险因素，并进一步使用病例对照比较进行评估。将 CHS 的结果与我们卫生系统中更高 TB 风险人群（难民和 TB 诊所）进行比较。
CHS 的 3745 例患者中有 79 例（2.1%）QFT 阳性。阳性率随年龄增加而增加（2-5 岁年龄组为 0.3%，13-18 岁年龄组为 4.9%）。不确定结果较为罕见（0.8%），包括 5 岁以下儿童。CHS 人群中阳性检测的危险因素包括非医疗补助保险/无保险和非英语/西班牙语首选语言。在病例对照分析中，出生/旅行到/居住在结核病流行国家是唯一确定的阳性检测危险因素（比值比 5.2 [95%CI 1.04-25.5]）。CHS 人群中的阳性检测率低于难民/TB 诊所人群，包括 2-5 岁儿童。
基于 QFT 的 LTBI 筛查在我们的儿科初级保健系统中成功实施，并支持我们确定 LTBI 病例的计划目标，同时限制不必要的 LTBI 治疗方案。随着年龄的增长阳性率增加，以及难民/TB 人群中的阳性率高于 CHS，这间接证明了该测试的敏感性足够，即使在干扰素-γ释放检测结果数据有限的幼儿中也是如此。
