National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics, Capital Medical University, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Department of Respiratory, Qilu Children's Hospital of Shandong University, Jinan, China.
BMC Infect Dis. 2021 Aug 13;21(1):815. doi: 10.1186/s12879-021-06480-2.
Identifying and prioritizing at-risk populations is critical for pediatric tuberculosis control. We aimed to identify a latent tuberculosis infection (LTBI) screening strategy that is appropriate for the Chinese context among children with different TB exposure levels and to explore its clinical importance.
During 2013-2015, we enrolled hospitalized children with suspected respiratory infectious disease (RID) for LTBI screening using the tuberculin skin test (TST) and interferon-γ release assay (IGRA) T-SPOT.TB as part of a work up for their RID. Participants with confirmed diagnosis were classified into three subgroups according to level of exposure to TB: no reported contact risk, with household contact risk, and with non-household contact risk.
A total 6202 children (median age: 4.76 years; interquartile range: 1.0-8.0 years) were enrolled. Children with no reported contact risk had the lowest proportions of positive results for the IGRA (0.7%) and TST (3.3%). The proportion of positive results for each test was higher for household contacts than non-household contacts. The TST positive proportion was much higher than that for the IGRA in all three groups. Children with IGRA+/TST+ results had larger indurations than those with IGRA- /TST+ results (15 mm vs. 13 mm, P = 0.02). For IGRA, older age (> 5 years) and non-household or household contact risk were associated with a positive result.
Positive IGRA results in children with a contact risk can serve as a critical reference for LTBI management. IGRA can be used, in preference to TST, for Chinese children with a TB exposure risk.
识别和确定高危人群对于控制儿童结核病至关重要。我们旨在确定一种适用于中国背景下不同结核接触水平儿童的潜伏性结核感染（LTBI）筛查策略，并探讨其临床重要性。
2013-2015 年，我们招募了因疑似呼吸道传染病（RID）住院的儿童，对其进行 LTBI 筛查，使用结核菌素皮肤试验（TST）和干扰素-γ释放测定（IGRA）T-SPOT.TB。对确诊患者根据结核接触水平分为三组：无报告接触风险、有家庭接触风险和有非家庭接触风险。
共纳入 6202 例儿童（中位年龄：4.76 岁；四分位间距：1.0-8.0 岁）。无报告接触风险的儿童 IGRA（0.7%）和 TST（3.3%）阳性比例最低。家庭接触者的两种检测阳性比例均高于非家庭接触者。在所有三组中，TST 的阳性比例均明显高于 IGRA。IGRA+/TST+ 结果的硬结直径大于 IGRA-/TST+ 结果（15 毫米比 13 毫米，P=0.02）。对于 IGRA，年龄较大（>5 岁）和非家庭或家庭接触风险与阳性结果相关。
有接触风险的儿童 IGRA 阳性结果可作为 LTBI 管理的重要参考。IGRA 可用于有结核接触风险的中国儿童，而不是 TST。
