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Original article

Vol. 150 No. 2324 (2020)

Prevalence of tuberculosis in migrant children in Switzerland and relevance of current screening guidelines

DOI
https://doi.org/10.4414/smw.2020.20253
Cite this as:
Swiss Med Wkly. 2020;150:w20253
Published
04.06.2020

Summary

AIMS

Since 2016, Swiss guidelines recommend screening of all migrant children <5 years of age for tuberculosis (TB) and to screen older children only if they have risk factors for tuberculosis. Our goals were to describe the epidemiology of latent tuberculosis in migrant children at the Lausanne University Hospital, to identify determinants of latent tuberculosis and tuberculosis disease, and to evaluate the risk of a false-positive tuberculin skin test when using a positivity limit of 5 mm.

METHODS

Newly arrived migrant children 0–18 years of age were prospectively enrolled from 31 August 2015 to 31 August 2017. Every migrant child was assessed for the risk of tuberculosis exposure and tuberculosis disease and was administered a tuberculin skin test. A tuberculosis-spot test was performed in children ≥5 years of age when the tuberculin skin test was positive. Children with clinical and/or radiological signs of tuberculosis disease were further investigated. Children ≥5 years of age with a positive tuberculosis-spot test and children <5 years of age with a positive tuberculin skin test, without clinico-radiological signs of tuberculosis disease received a diagnosis of latent tuberculosis. A false-positive tuberculin skin test result was diagnosed in children ≥5 years of age when the tuberculosis-spot test was negative. Potential determinants of tuberculosis (latent tuberculosis and tuberculosis disease) and of false-positive tuberculin skin tests were identified. Student’s t-test or the Kruskal-Wallis test were used for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. All variables with a p-value <0.05 were included in a multivariate logistic regression model.

RESULTS

Two hundred and fifty-three patients were eligible for the study. The median age of the patients was 8.1 years (interquartile range [IQR] 4.5–12.8) and 104 (41%) were female. Twenty-four percent of the patients (62/253) came from a country with a moderate–high incidence of tuberculosis disease (≥80 cases per 100,000 individuals). Twenty-eight patients (11%) had positive tuberculin skin tests, and tuberculosis was confirmed in 17 (6.7%) of these patients (16 with latent tuberculosis and 1 with tuberculosis disease). On multivariate analysis, moderate–high incidence of tuberculosis disease in the country of origin (adjusted odds ratio [aOR] 18.8, 95% confidence interval [CI] 5.1–68.6; p <0.001), older age (aOR 1.1, 95% CI 1.0–1.3; p = 0.025), and contact with a tuberculosis disease patient (aOR 8, 95% CI 1.8–36.2; p = 0.007) were associated with a diagnosis of tuberculosis. Among the 23 children over 5 years of age who had a positive tuberculin skin test with measurement available, a measure between 5–9 mm was more frequent in case of a false-positive tuberculin skin test (5/9, 56% vs 0/14, 0%, p = 0.002). BCG vaccination was the only predictor of a false-positive tuberculin skin test (p = 0.03).

CONCLUSION

Screening migrant children ≥5 years of age for tuberculosis could confer a public health benefit even in the absence of other risk factors. The limit of tuberculin skin test positivity could be raised from ≥5 mm to ≥10 mm to decrease the rate of false-positive results. A national assessment of migrant children between the ages of 5 and 15 should be carried out to confirm our findings.

References

  1. World Health Organization. Global tuberculosis report 2018 [Internet]. World Health Organization, editor. 2018. 174 p. Available from: https://www.who.int/tb/publications/global_report/gtbr2018_main_text_30Oct2018.pdf? ua=1
  2. Office fédérale de la santé publique OFSP. Stratégie nationale de lutte contre la tuberculose 2012–2017 [Internet]. Office fédérale de la santé publique OFSP. 2012. 23 p. Available from: www.bag.admin.ch
  3. Bernhard-Stirnemann S, Büttcher M, Heininger U, Relly C, Trück J, Wagner N, et al. Mémento pour le diagnostic et la prévention de maladies infectieuses et la mise à jour des vaccinations auprès d’enfants et adolescents migrants en Suisse, asymptomatiques. Paediatrica. 2016??:11–8.
  4. Cain KP, Benoit SR, Winston CA, Mac Kenzie WR. Tuberculosis among foreign-born persons in the United States. JAMA. 2008;300(4):405–12. doi:.https://doi.org/10.1001/jama.300.4.405
  5. Federal Office of Public Health. Tuberculosis in Switzerland, guidance for healthcare professionals, Manual of Tuberculosis - revised version, Federal Office of Public Health. March 2019
  6. Wang Z, Wang Z. Latent Tuberculosis Infection among Immigrant and Refugee Children Aged 2-14 Years Who Arrived in the United States in 2008-2012 [Internet]. Georgia State University; 2015. pp. 1–42. Available from: https://scholarworks.gsu.edu/iph_theses/411
  7. Grinsdale JA, Islam S, Tran OC, Ho CS, Kawamura LM, Higashi JM. Interferon-Gamma Release Assays and Pediatric Public Health Tuberculosis Screening: The San Francisco Program Experience 2005 to 2008. J Pediatric Infect Dis Soc. 2016;5(2):122–30. doi:.https://doi.org/10.1093/jpids/piu119
  8. Howley MM, Painter JA, Katz DJ, Graviss EA, Reves R, Beavers SF, et al.; Tuberculosis Epidemiologic Studies Consortium. Evaluation of QuantiFERON-TB gold in-tube and tuberculin skin tests among immigrant children being screened for latent tuberculosis infection. Pediatr Infect Dis J. 2015;34(1):35–9. doi:.https://doi.org/10.1097/INF.0000000000000494
  9. Garazzino S, Galli L, Chiappini E, Pinon M, Bergamini BM, Cazzato S, et al.; SITIP IGRA Study Group. Performance of interferon-γ release assay for the diagnosis of active or latent tuberculosis in children in the first 2 years of age: a multicenter study of the Italian Society of Pediatric Infectious Diseases. Pediatr Infect Dis J. 2014;33(9):e226–31. doi:.https://doi.org/10.1097/INF.0000000000000353
  10. Adams LV, Starke JR. Latent tuberculosis infection in children. In: Reyn von CF, Edwards MS, editors. UpToDate [Internet]. Waltham, MA: UpToDate. Available from: https://uptodate.com (accessed on 2018 October 23)
  11. Pareek M, Baussano I, Abubakar I, Dye C, Lalvani A. Evaluation of immigrant tuberculosis screening in industrialized countries. Emerg Infect Dis. 2012;18(9):1422–9. doi:.https://doi.org/10.3201/eid1809.120128
  12. Usdin M, Dedicoat M, Gajraj R, Harrison P, Kaur H, Duffield K, et al. Latent tuberculous screening of recent migrants attending language classes: a cohort study and cost analysis. Int J Tuberc Lung Dis. 2017;21(2):175–80. doi:.https://doi.org/10.5588/ijtld.16.0398
  13. Porco TC, Lewis B, Marseille E, Grinsdale J, Flood JM, Royce SE. Cost-effectiveness of tuberculosis evaluation and treatment of newly-arrived immigrants. BMC Public Health. 2006;6(1):157. doi:.https://doi.org/10.1186/1471-2458-6-157
  14. Adams LV, Starke JR. Tuberculosis disease in children. In: Reyn von CF, Edwards MS, editors. UpToDate. Waltham, MA: UpToDate. (accessed on 2018 October 23)
  15. World Health Organization. The End TB Strategy [Internet]. World Health Organization, editor. 2015 [cited 2019 Apr 24]. pp. 1–30. Available from: https://www.who.int/tb/strategy/End_TB_Strategy.pdf?ua=1
  16. Rudin C, Bernet V, Posfay-Barbe KM, Bolt I, Laubscher B, Simonetti G, et al. SPSU Swiss paediatric surveillance unit, annual report 2017. 2018;49:10–25. Available from: https://www.bag.admin.ch/bag/fr/home/das-bag/publikationen/periodika/bag-bulletin.html
  17. Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis. 2017;64(2):e1–33. doi:.https://doi.org/10.1093/cid/ciw694
  18. Harries AD, Maher D, Graham SM, Graham S. TB/VIH. World Health Organization. Organisation mondiale de la Santé; 2005. 220 p.
  19. Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis. 2006;10(11):1192–204.
  20. Yun KW, Kim YK, Kim HR, Lee MK, Lim IS. Usefulness of interferon-γ release assay for the diagnosis of latent tuberculosis infection in young children. Korean J Pediatr. 2016;59(6):256–61. doi:.https://doi.org/10.3345/kjp.2016.59.6.256

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