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Tuberculin skin test, interferon-gamma release assay and incidence of tuberculosis in migrant children. Rutger Bennet, Sahar Nejat Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden.

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Astrid Lindgren Children’s Hospital, Emergency and Infectious Disease Department

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Astrid lindgren children s hospital emergency and infectious disease department

Tuberculin skin test, interferon-gamma release assay and incidence of tuberculosis in migrant children

Rutger Bennet, Sahar Nejat Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden

IntroductionIn Sweden TB is common in the foreign born, and all immigrants are offered tuberculin skin test (TST) screening. However, previous investigation of young migrant TST screening in Stockholm, showed poor correlation between TST positivity (≥10mm) to incidence of tuberculosis in the country of origin (Poster at ESPID, the Hague 2011). We therefore wanted to investigate the correlation of IGRA test to both TST and TB incidence.

Method

All TST positive (>10mm) migrants were referred to our TB clinic, where a complementary IGRA test (usually a Quantiferon) was usually performed*. TST and IGRA results were correlated to the local TB incidences previously calculated according to country of origin (Pediatr Infect Dis J 2012).

Figs 1-4. TST and IGRA in 496 migrants (<18 yr) to Stockholm 2006-2013; grouped by origin. *Data in shaded areas are incomplete (those with TST < 10 mm not referred but picked up by us because, e.g.,of TST/IGRA positive siblings; migrants from high incidence countries witha TST > 15 mm usually not IGRA tested , as they would be treated irrespective of IGRA results).

n

n

n

n

IGRA

IGRA

IGRA

IGRA

TST (mm)

TST (mm)

TST (mm)

TST (mm)

Eastern Europe, former U.S.S.R.

Southwest Asia and North Africa

High-incidence** countries except Somalia

Somalia

** >100/100.000 as estimated by WHO

%

Fig 5. TST and IGRA positive fractionsin relation to local TB incidence in migrants (<18 yr) to Stockholm 2006-2012.

TB incidence (cases/100.000 person years) in foreign born Stockholm children (< 18 yr)

  • Conclusion

  • As expected, the rate of IGRA positivity, being more specific than TST, was highest and best correlated to TST in high incidence groups.

  • The correlation to TST was especially poor in migrants from Eastern Europe/former U.S.S.R., perhaps due to routine TST, with or without repeat BCG vaccination of TST negative schoolchildren.

  • Among those considered TST negative at screening, some had a positive IGRA test.

  • TST screening of young migrants may not be an optimal way of finding those who would benefit from LTBI treatment.

Astrid Lindgren Children’s Hospital, Emergency and Infectious Disease Department

Dr. Rutger Bennet

E-mail: [email protected]


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