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Interpretation of repeat tuberculin skin testing in international adoptees: conversions or boosting.
Pediatr Infect Dis J. 2008 Oct; 27(10):913-9.PI

Abstract

BACKGROUND

Internationally-adopted children are a unique group of Bacille Calmette-Guérin (BCG)-vaccinated children with high rates of latent tuberculosis infection (LTBI) in whom serial tuberculin skin tests (TST) are recommended. No study has measured the incidence of TST conversion in these children.

METHODS

Internationally-adopted children completed baseline and follow-up TST to measure the incidence of Mycobacterium tuberculosis infection and factors associated with TST conversion. Data were collected regarding age, gender, birth country, vaccination history, history of tuberculosis (TB) exposure, previous TB screening, and preadoptive environment. All children completed physical examinations including a standardized evaluation for TB, anthropometric assessment, and documentation of BCG scar.

RESULTS

Fourteen percent of children (N = 390) had evidence of LTBI at baseline. Children were more likely to have LTBI if they were older, BCG vaccinated, or had been in the United States longer. An additional 13% of children had TST indurations > or = 10 mm at follow-up testing. Regardless of BCG vaccination status or nutritional status, children who were younger at baseline were more likely to have a TST induration > or = 10 mm at follow-up.

CONCLUSIONS

International adoptees have significant risk of LTBI. Although our findings suggest that recent infection with M. tuberculosis led to TST conversion in some children, the increase in follow-up TST induration could also be attributed to TST boosting resulting from prior BCG vaccination. When serial TST testing is completed in young, BCG-vaccinated children, interpretation of the follow-up TST should consider baseline TST results.

Authors+Show Affiliations

Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA. anna.mandalakas@case.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18776820

Citation

Mandalakas, Anna M., et al. "Interpretation of Repeat Tuberculin Skin Testing in International Adoptees: Conversions or Boosting." The Pediatric Infectious Disease Journal, vol. 27, no. 10, 2008, pp. 913-9.
Mandalakas AM, Kirchner HL, Zhu X, et al. Interpretation of repeat tuberculin skin testing in international adoptees: conversions or boosting. Pediatr Infect Dis J. 2008;27(10):913-9.
Mandalakas, A. M., Kirchner, H. L., Zhu, X., Yeo, K. T., & Starke, J. R. (2008). Interpretation of repeat tuberculin skin testing in international adoptees: conversions or boosting. The Pediatric Infectious Disease Journal, 27(10), 913-9. https://doi.org/10.1097/INF.0b013e3181758187
Mandalakas AM, et al. Interpretation of Repeat Tuberculin Skin Testing in International Adoptees: Conversions or Boosting. Pediatr Infect Dis J. 2008;27(10):913-9. PubMed PMID: 18776820.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interpretation of repeat tuberculin skin testing in international adoptees: conversions or boosting. AU - Mandalakas,Anna M, AU - Kirchner,H Lester, AU - Zhu,Xaiobei, AU - Yeo,Kee Thai, AU - Starke,Jeffrey R, PY - 2008/9/9/pubmed PY - 2008/10/22/medline PY - 2008/9/9/entrez SP - 913 EP - 9 JF - The Pediatric infectious disease journal JO - Pediatr Infect Dis J VL - 27 IS - 10 N2 - BACKGROUND: Internationally-adopted children are a unique group of Bacille Calmette-Guérin (BCG)-vaccinated children with high rates of latent tuberculosis infection (LTBI) in whom serial tuberculin skin tests (TST) are recommended. No study has measured the incidence of TST conversion in these children. METHODS: Internationally-adopted children completed baseline and follow-up TST to measure the incidence of Mycobacterium tuberculosis infection and factors associated with TST conversion. Data were collected regarding age, gender, birth country, vaccination history, history of tuberculosis (TB) exposure, previous TB screening, and preadoptive environment. All children completed physical examinations including a standardized evaluation for TB, anthropometric assessment, and documentation of BCG scar. RESULTS: Fourteen percent of children (N = 390) had evidence of LTBI at baseline. Children were more likely to have LTBI if they were older, BCG vaccinated, or had been in the United States longer. An additional 13% of children had TST indurations > or = 10 mm at follow-up testing. Regardless of BCG vaccination status or nutritional status, children who were younger at baseline were more likely to have a TST induration > or = 10 mm at follow-up. CONCLUSIONS: International adoptees have significant risk of LTBI. Although our findings suggest that recent infection with M. tuberculosis led to TST conversion in some children, the increase in follow-up TST induration could also be attributed to TST boosting resulting from prior BCG vaccination. When serial TST testing is completed in young, BCG-vaccinated children, interpretation of the follow-up TST should consider baseline TST results. SN - 0891-3668 UR - https://www.unboundmedicine.com/medline/citation/18776820/Interpretation_of_repeat_tuberculin_skin_testing_in_international_adoptees:_conversions_or_boosting_ L2 - https://doi.org/10.1097/INF.0b013e3181758187 DB - PRIME DP - Unbound Medicine ER -