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Prevalence and factors associated with tuberculosis infection among new school entrants, New York City, 1991-1993.
Int J Tuberc Lung Dis. 1999 Jan; 3(1):31-41.IJ

Abstract

SETTING

New York City public (or state-run) and private schools-elementary and secondary.

OBJECTIVE

To describe the prevalence and determine factors associated with positive tuberculin skin tests (TSTs) in school children.

DESIGN

Mandatory TST surveys among cohorts of new school entrants for the 1991, 1992 and 1993 school years, of whom birthplace was known for 81%. A positive tuberculin skin test defined as > or =10 mm induration.

RESULTS

Of the 298506 new school entrants, 2.1% (6326) were tuberculin test positive. The proportion that was tuberculin test positive was 0.5% (931/199 728) among US-born and 9.2% (3794/41 346) among foreign-born students. Foreign-born (FB) students with a history of BCG vaccination were much more likely to have a positive tuberculin test than US-born students (13.6% vs. 0.5%, odds ratio [OR] = 33.6, 95% confidence interval [CI] 31.7, 35.6), and were more likely to have a positive tuberculin test than FB students with no history of BCG (13.6% vs. 4.4%, OR = 3.4, 95% CI 2.5, 4.6). Older age was independently associated with tuberculin test positivity, except among foreign-born BCG-vaccinated children, in whom the youngest were more likely to have a positive tuberculin test.

CONCLUSIONS

Even in the midst of a tuberculosis resurgence such as that experienced by New York City, where tuberculosis cases nearly tripled from 1978 to 1992, the risk of tuberculosis infection among school children remained quite low. Given the reduced predictive value of the tuberculin test among low risk children and the effects of BCG vaccination, many children (especially younger children) with positive tuberculin test results are probably not infected with Mycobacterium tuberculosis. To reduce unnecessary evaluation and treatment, routine tuberculin tests should be administered only to high risk groups such as older children from countries with high rates of tuberculosis.

Authors+Show Affiliations

Bureau of Tuberculosis Control, New York City Department of Health, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10094167

Citation

Scholten, J N., et al. "Prevalence and Factors Associated With Tuberculosis Infection Among New School Entrants, New York City, 1991-1993." The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease, vol. 3, no. 1, 1999, pp. 31-41.
Scholten JN, Fujiwara PI, Frieden TR. Prevalence and factors associated with tuberculosis infection among new school entrants, New York City, 1991-1993. Int J Tuberc Lung Dis. 1999;3(1):31-41.
Scholten, J. N., Fujiwara, P. I., & Frieden, T. R. (1999). Prevalence and factors associated with tuberculosis infection among new school entrants, New York City, 1991-1993. The International Journal of Tuberculosis and Lung Disease : the Official Journal of the International Union Against Tuberculosis and Lung Disease, 3(1), 31-41.
Scholten JN, Fujiwara PI, Frieden TR. Prevalence and Factors Associated With Tuberculosis Infection Among New School Entrants, New York City, 1991-1993. Int J Tuberc Lung Dis. 1999;3(1):31-41. PubMed PMID: 10094167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and factors associated with tuberculosis infection among new school entrants, New York City, 1991-1993. AU - Scholten,J N, AU - Fujiwara,P I, AU - Frieden,T R, PY - 1999/3/27/pubmed PY - 2000/3/18/medline PY - 1999/3/27/entrez SP - 31 EP - 41 JF - The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease JO - Int J Tuberc Lung Dis VL - 3 IS - 1 N2 - SETTING: New York City public (or state-run) and private schools-elementary and secondary. OBJECTIVE: To describe the prevalence and determine factors associated with positive tuberculin skin tests (TSTs) in school children. DESIGN: Mandatory TST surveys among cohorts of new school entrants for the 1991, 1992 and 1993 school years, of whom birthplace was known for 81%. A positive tuberculin skin test defined as > or =10 mm induration. RESULTS: Of the 298506 new school entrants, 2.1% (6326) were tuberculin test positive. The proportion that was tuberculin test positive was 0.5% (931/199 728) among US-born and 9.2% (3794/41 346) among foreign-born students. Foreign-born (FB) students with a history of BCG vaccination were much more likely to have a positive tuberculin test than US-born students (13.6% vs. 0.5%, odds ratio [OR] = 33.6, 95% confidence interval [CI] 31.7, 35.6), and were more likely to have a positive tuberculin test than FB students with no history of BCG (13.6% vs. 4.4%, OR = 3.4, 95% CI 2.5, 4.6). Older age was independently associated with tuberculin test positivity, except among foreign-born BCG-vaccinated children, in whom the youngest were more likely to have a positive tuberculin test. CONCLUSIONS: Even in the midst of a tuberculosis resurgence such as that experienced by New York City, where tuberculosis cases nearly tripled from 1978 to 1992, the risk of tuberculosis infection among school children remained quite low. Given the reduced predictive value of the tuberculin test among low risk children and the effects of BCG vaccination, many children (especially younger children) with positive tuberculin test results are probably not infected with Mycobacterium tuberculosis. To reduce unnecessary evaluation and treatment, routine tuberculin tests should be administered only to high risk groups such as older children from countries with high rates of tuberculosis. SN - 1027-3719 UR - https://www.unboundmedicine.com/medline/citation/10094167/Prevalence_and_factors_associated_with_tuberculosis_infection_among_new_school_entrants_New_York_City_1991_1993_ L2 - https://www.ingentaconnect.com/openurl?genre=article&issn=1027-3719&volume=3&issue=1&spage=31&aulast=Scholten DB - PRIME DP - Unbound Medicine ER -