Appendix 1. Children Who Should Be Tested For Tuberculosis
A child who has been infected with tuberculosis (TB) may show no outward symptoms. However, infection can later lead to severe illness. To detect the problem before a child becomes ill, we perform a tuberculosis skin test.
Instead of testing all children as we have in the past, we recommend that only some children should have a skin test. If a test is warranted, the child will be tested with the intermediate PPD (Mantoux) skin test, because it is the most accurate available. We no longer recommend use of the less accurate multiple puncture skin tests, such as the Tine or Mono-vacc.
To help your child's health care provider determine if your child needs to be skin tested, please answer the following questions:
- Has your child lived with or spent time with anyone who possibly or definitely had tuberculosis?
- Does anyone living in the child's household have a positive skin test for tuberculosis?
- Did you (parent or guardian), your child, or anyone else living in your household come to the United States from another country?
- Has your child traveled to or lived in another country for more than a month?
If your child has had a positive skin test for tuberculosis in the past, inform your child's health care provider. Your child will not need another test.
IF YOU HAVE ANY QUESTIONS ABOUT YOUR CHILD'S NEED FOR A TUBERCULOSIS SKIN TEST, PLEASE ASK YOUR CHILD'S HEALTH CARE PROVIDER!
Revised July, 2001
Table 1. Definitions of Positive Mantoux Skin Test (5 Tuberculin Units of Purified Protein Derivative) in Infants, Children and Adolescents*
INDURATION > 5 MM
Children in close contact with known or suspected contagious cases of tuberculosis
Children suspected to have tuberculosis disease
- Chest radiograph consistent with active or previously active tuberculosis
- Clinical evidence of tuberculosis
Children receiving immunosuppressive therapy† or with immunosuppressive conditions, including HIV infection
INDURATION > 10 MM
Children at increased risk of dissemination because of
- Young age: less than 4 years of age
- Other medical conditions, including Hodgkin disease, lymphoma, diabetes mellitus, chronic renal failure, or malnutrition
Children with increased risk of exposure to tuberculosis
- Born, or whose parents or other household members were born, in high-prevalence regions of the world
- Travel and exposure to high-prevalence regions of the world
- Parents or other household members have latent tuberculosis infection
INDURATION > 15 MM
Children 4 years of age or older without any risk factors
*Modified from American Academy of Pediatrics. Report of the Committee on Infectious Diseases. Red Book
2000. 25th Edition. Elks Grove Village, IL; 2000: 594. Tests should be read at 48-72 hours after placement. These definitions apply regardless of previous bacille Calmette-Guerin (BCG) immunization.
† Including immunosuppressive doses of corticosteroids.
The following areas have a high prevalence of tuberculosis and are considered "high risk":
- Latin America and the Caribbean
- Middle East
- Former socialist economies (Eastern Europe and the former Soviet Union)
The following areas/countries have a low prevalence of tuberculosis and are considered "low risk" for tuberculosis*:
- Western Europe
- New Zealand
In Massachusetts in 2000, the largest number of tuberculosis cases among persons born in a foreign country were from: Haiti, Vietnam, China, India, Dominican Republic, Brazil and Cambodia. There were also cases from 43 other countries.
*Individual risk factors should always be considered, even when child is from a low risk area.
- Contacts of persons with confirmed or suspected infectious tuberculosis
- Children with radiographic or clinical findings suggesting tuberculosis
- Children who have immigrated from endemic countries
- Children whose parents or other household members immigrated from endemic countries
- Children whose parents or other household members have latent tuberculosis infection (i.e. positive skin test for tuberculosis and negative chest x-ray)
- Children with travel to endemic countries
- Children infected with HIV
- Incarcerated adolescents
TEST PROMPTLY AND PERIODICALLY†
Children with potential exposure to tuberculosis and who have increased risk for progression to severe tuberculosis:
- Diabetes mellitus
- Chronic renal failure
- Congenital or acquired immunodeficiencies
TEST BEFORE INITIATING IMMUNOSUPPRESSIVE THERAPY
Children with underlying conditions that necessitate immunosuppressive therapy should have an initial tuberculin skin test before initiation of immunosuppressive therapy.
* Modified from American Academy of Pediatrics. Report of the Committee on Infectious Diseases.
Red Book 2000. 25th Edition. Elks Grove Village, IL; 2000: 597. HIV indicates human immunodeficiency virus.
† The American Academy of Pediatrics does not specify a time interval.