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Interferon‐gamma release assays can effectively screen migrants for the tuberculosis infection, but urgent, active cases need clinical recognition
Author(s) -
Nejat Sahar,
Bennet Rutger
Publication year - 2016
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.13386
Subject(s) - medicine , tuberculosis , tuberculin , incidence (geometry) , pediatrics , population , interferon gamma release assay , active tuberculosis , demography , mycobacterium tuberculosis , environmental health , latent tuberculosis , pathology , physics , optics , sociology
Aim Increasing numbers of migrants to Sweden are screened for tuberculosis ( TB ), and a rational approach to screening is required. We evaluated positive tuberculin skin tests ( TST s) and interferon‐gamma release assays ( IGRA s) on paediatric migrants in relation to the TB incidence in the corresponding foreign‐born populations in Stockholm. Methods This study examined the characteristics of migrants under the age of 18 who were referred to a paediatric TB clinic at Karolinska University Hospital from 2008 to 2014 by primary care centres in Stockholm County. Results We saw 943 TST ‐positive children with a median age of 14 years at the TB clinic and performed IGRA s on 557. IGRA positivity ranged from 64% in migrants from Somalia to 20% in those from the former Soviet Union and eastern Europe, with an estimated population level prevalence of 18.8% and 4.2%, respectively. These were significantly correlated to TB incidence in foreign‐born Stockholm children. We diagnosed active TB in 20 screened migrants, and advanced, symptomatic TB was diagnosed in 10 recently arrived migrants without screening. Conclusion IGRA s showed higher specificity than TST in identifying tuberculosis. TB screening should focus on migrants from high‐incidence countries, but this may be inadequate to detect advanced TB cases.