Targeted Tuberculin Skin Testing and Treatment of Latent Tuberculosis Infection in Children and Adolescents

Comprehensive new guidelines for screening, targeted testing, and treating latent tuberculosis infection (LTBI) in children and adolescents are presented. The recent epidemiology of TB and data on risk factors for LTBI are reviewed. The evidence-based recommendations provided emphasize the paradigm that children and adolescents should be screened for risk factors by using a risk-factor questionnaire for TB and LTBI and tested with the tuberculin skin test only if >1 risk factor is present. The use of administrative or mandated tuberculin skin tests for entry to day care, school, or summer camp is strongly discouraged. Treatment regimens, suggestions to improve adherence, and methods to monitor toxicities are summarized. Children and adolescents with LTBI represent the future reservoir for cases of TB. Thus, detecting and treating LTBI in children and adolescents will contribute to the elimination of TB in the United States. Pediatrics 2004;114:1175–1201; latent tuberculosis infection, tuberculin skin test, children, adolescents, pediatrics, tuberculosis. ABBREVIATIONS. TB, tuberculosis; LTBI, latent tuberculosis infection; USPHS, United States Public Health Service; CDC, Centers for Disease Control and Prevention; TST, tuberculin skin test; HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; AAP, American Academy of Pediatrics; TU, tuberculin units; PPD, purified protein derivative; MPT, multiplepuncture test; INH, isoniazid; DOT, directly observed therapy; MDR, multidrug-resistant; BCG, bacillus Calmette-Guérin; TNF, tumor necrosis factor ; CT, computed tomography; DTH, delayed-type hypersensitivity; NTM, nontuberculous mycobacteria; ESAT-6, early secreted antigenic target 6 kDa; QFT, QuantiFERON-TB; IFN, interferon ; ELISPOT, enzyme-linked immunospot; OR, odds ratio; CI95, 95% confidence interval.