Tuberculosis Screening in Internationally Adopted Children: The Need for Initial and Repeat Testing

Author:

Trehan Indi12,Meinzen-Derr Jareen K.1,Jamison Linda1,Staat Mary Allen13

Affiliation:

1. Department of Pediatrics

2. Department of Pediatrics, Washington University and St Louis Children's Hospital, St Louis, Missouri

3. International Adoption Center, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Abstract

OBJECTIVE. Because most internationally adopted children come from areas of high tuberculosis prevalence, an initial tuberculin skin test is recommended after arrival to the United States. We evaluated whether repeat testing of children ≥3 months after arrival to the United States would identify additional children with latent tuberculosis infection. METHODS. Internationally adopted children who were seen at our International Adoption Center and had a tuberculin skin test within 2 months of arrival to the United States were eligible for the study. Children not diagnosed with tuberculosis with initial testing were retested at least 3 months later. The prevalence of tuberculosis on arrival and after repeat testing was determined, and potential risk factors for infection were examined. RESULTS. Of the 527 internationally adopted children with an initial tuberculin skin test completed, 111 (21%) had evidence of latent tuberculosis infection. Repeat tuberculosis testing was complete for 191 internationally adopted children (46.9% of those who had an initially negative tuberculin skin test). Latent tuberculosis infection was found in 20% of those who were retested. No children were found to have active tuberculosis disease. Children with an initially positive tuberculin skin test result had slightly higher weight-for-age z scores at their initial clinic visit, whereas those whose tuberculin skin test result was positive after repeat testing had slightly lower weight-for-age z scores. A strong correlation between BCG immunization and tuberculin skin test result was observed. CONCLUSIONS. Latent tuberculosis infection is common in internationally adopted children. A high proportion of internationally adopted children had an initially false-negative tuberculin skin test. Repeat tuberculosis testing of all internationally adopted children with an initially negative tuberculin skin test should be the standard of care for identifying tuberculosis infection and preventing tuberculosis disease in this high-risk population.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference41 articles.

1. US Department of State. Immigrant visas issues to orphans coming to U.S. Available at: http://travel.state.gov/family/adoption/stats/stats_451.html. Accessed December 19, 2007

2. Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics;2006

3. Nelson LJ, Schneider E, Wells CD, Moore M. Epidemiology of childhood tuberculosis in the United States, 1993–2001: the need for continued vigilance. Pediatrics.2004;114(2):333–341

4. Taylor Z, Nolan CM, Blumberg HM; American Thoracic Society; Centers for Disease Control and Prevention; Infectious Diseases Society of America. Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America [published correction appears in MMWR Morb Mortal Wkly Rep. 2005;54(45):1161]. MMWR Recomm Rep.2005;54(RR-12):1–81

5. Horsburgh CR Jr. Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med.2004;350(20):2060–2067

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