Journal of Pediatrics
Volume 200, 2018, Pages 202-209

Interferon-Gamma Release Assay-Based Screening for Pediatric Latent Tuberculosis Infection in an Urban Primary Care Network (Article)

Gaensbauer J.* , Gonzales B. , Belknap R. , Wilson M.L. , O'Connor M.E.
  • a Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO, United States, Denver Metro Tuberculosis Clinic, Denver Public Health, Denver, CO, United States, Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States, Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
  • b Department of Pediatrics, Denver Health and Hospital Authority, Denver, CO, United States
  • c Denver Metro Tuberculosis Clinic, Denver Public Health, Denver, CO, United States, Department of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, United States
  • d Department of Pathology and Laboratory Services, Denver Health and Hospital Authority, Denver, CO, United States, Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States
  • e Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States, Children's Hospital, Dartmouth-Hitchcock, Lebanon, NH, United States, Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH, United States

Abstract

Objective: 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. Study design: 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. Results: 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. Discussion: 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. © 2018 Elsevier Inc.

Author Keywords

Screening interferon gamma release assay Tuberculosis Infection Pediatrics

Index Keywords

urban population primary medical care refugee multicenter study mass screening population clinical trial Follow-Up Studies follow up human clinical assessment risk assessment trends health service interferon gamma release assay priority journal Interferon-gamma Release Tests controlled study comparative study morbidity pediatrics screening test Urban Health Services procedures Humans Adolescent male latent tuberculosis preschool child female risk factor Risk Factors Child, Preschool high risk population prevalence Article health care Retrospective Studies major clinical study tuberculin test adult infection risk outcome assessment medicaid Case-Control Studies retrospective study case control study primary health care Child public health Colorado
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85048488587&doi=10.1016%2fj.jpeds.2018.04.034&partnerID=40&md5=314ec1baab88ffc458e289c30c82e4f7
DOI: 10.1016/j.jpeds.2018.04.034
ISSN: 00223476
Cited by: 4
Original Language: English