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Turner NA, Ahmed A, Haley CA, Starke JR, Stout JE. Use of Interferon-Gamma Release Assays in Children <2 Years Old. J Pediatric Infect Dis Soc 2023; 12:481-485. [PMID: 37478309 DOI: 10.1093/jpids/piad053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/20/2023] [Indexed: 07/23/2023]
Abstract
While interferon-gamma release assays (IGRAs) are widely used for detecting tuberculosis (TB) infection, tuberculin skin tests (TSTs) remain preferred for children under the age of 2 years. The preference for TST stems from concern over IGRA sensitivity in young children. However, TSTs are susceptible to false-positive results following Bacille Calmette-Guérin (BCG) vaccination, which is common in infancy, and exposure to nontuberculous mycobacteria. We reviewed available data for IGRA performance in children under age 2 years. Across four cohorts of high-risk children under age 2 (mostly case contacts or those born in tuberculosis endemic regions), 0 of 575 untreated children with negative IGRA test results progressed to tuberculosis disease-including 0 of 70 who were TST positive but IGRA negative. While neither TSTs nor IGRAs are perfectly sensitive for the diagnosis of tuberculosis infection, IGRAs are an acceptable alternative to TST in children <2 years of age.
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Affiliation(s)
- Nicholas A Turner
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amina Ahmed
- Pediatric Infectious Disease and Immunology, Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Connie A Haley
- Division of Infectious Diseases and Global Medicine, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jeffrey R Starke
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Jason E Stout
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA
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Starke JR, Erkens C, Ritz N, Kitai I. Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings. Pathogens 2022; 11:158. [PMID: 35215101 PMCID: PMC8877840 DOI: 10.3390/pathogens11020158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 01/22/2023] Open
Abstract
In low tuberculosis-burden countries, children and adolescents with the highest incidence of tuberculosis (TB) infection or disease are usually those who have immigrated from high-burden countries. It is, therefore, essential that low-burden countries provide healthcare services to immigrant and refugee families, to assure that their children can receive proper testing, evaluation, and treatment for TB. Active case-finding through contact tracing is a critical element of TB prevention in children and in finding TB disease at an early, easily treated stage. Passive case-finding by evaluating an ill child is often delayed, as other, more common infections and conditions are suspected initially. While high-quality laboratory services to detect Mycobacterium tuberculosis are generally available, they are often underutilized in the diagnosis of childhood TB, further delaying diagnosis in some cases. Performing research on TB disease is difficult because of the low number of cases that are spread over many locales, but critical research on the evaluation and treatment of TB infection has been an important legacy of low-burden countries. The continued education of medical providers and the involvement of educational, professional, and non-governmental organizations is a key element of maintaining awareness of the presence of TB. This article provides the perspective from North America and Western Europe but is relevant to many low-endemic settings. TB in children and adolescents will persist in low-burden countries as long as it persists throughout the rest of the world, and these wealthy countries must increase their financial commitment to end TB everywhere.
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Affiliation(s)
- Jeffrey R. Starke
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA
| | - Connie Erkens
- KNCV Tuberculosis Foundation, 2516 AB The Hague, The Netherlands;
| | - Nicole Ritz
- Department of Paediatrics and Paediatric Infectious Diseases, Children’s Hospital, Lucerne Cantonal Hospital, 6000 Lucerne, Switzerland;
- Mycobacterial and Migrant Health Research Group, Department of Clinical Research, University of Basel Children’s Hospital, University of Basel, 4031 Basel, Switzerland
| | - Ian Kitai
- Department of Pediatrics, Division of Infectious Diseases, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada;
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Kumar GS, Pezzi C, Payton C, Mamo B, Urban K, Scott K, Montour J, Cabanting N, Aguirre J, Ford R, Hughes SE, Kawasaki B, Kennedy L, Jentes ES. Health of Asylees Compared to Refugees in the United States Using Domestic Medical Examination Data, 2014-2016: A Cross-Sectional Analysis. Clin Infect Dis 2021; 73:1492-1499. [PMID: 34043768 DOI: 10.1093/cid/ciab502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Between 2008 and 2018, persons granted asylum (asylees) increased by 168% in the United States. Asylees are eligible for many of the same domestic benefits as refugees under the US Refugee Admissions Program (USRAP), including health-related benefits such as the domestic medical examination. However, little is known about the health of asylees to guide clinical practice. METHODS We conducted a retrospective cross-sectional analysis of domestic medical examination data from nine US sites from 2014 to 2016. We describe and compare demographics and prevalence of several infectious diseases such as latent tuberculosis infection (LTBI), hepatitis B and C, and select sexually transmitted infections and parasites by refugee or asylee visa status. RESULTS The leading nationalities for all asylees were China (24%) and Iraq (10%), while the leading nationalities for refugees were Burma (24%) and Iraq (19 %). Approximately 15% of asylees were diagnosed with LTBI, and 52% of asylee adults were susceptible to HBV infection. Prevalence of LTBI (Prevalence Ratio [PR]=0.8), hepatitis B (0.7), hepatitis C (0.5) and Strongyloides (0.5) infections were significantly lower among asylees than refugees. Prevalence of other reported conditions did not differ by visa status. CONCLUSIONS Compared to refugees, asylees included in our dataset were less likely to be infected with some infectious diseases but had similar prevalence of other reported conditions. The Centers for Disease Control and Prevention's Guidance for the US Domestic Medical Examination for Newly Arrived Refugees can also assist clinicians in the care of asylees during the routine domestic medical examination.
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Affiliation(s)
| | - Clelia Pezzi
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Colleen Payton
- Thomas Jefferson University, Philadelphia, PA.,Moravian College, Bethlehem, PA, USA
| | - Blain Mamo
- Minnesota Department of Health, Saint Paul, MN, USA
| | - Kailey Urban
- Minnesota Department of Health, Saint Paul, MN, USA
| | - Kevin Scott
- Thomas Jefferson University, Philadelphia, PA
| | | | - Nuny Cabanting
- California Department of Public Health, Sacramento, CA, USA
| | - Jenny Aguirre
- Illinois Department of Healthcare and Family Services, Chicago, IL, USA
| | - Rebecca Ford
- Kentucky Office for Refugees, Louisville, KY, USA
| | | | - Breanna Kawasaki
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Lori Kennedy
- Colorado Department of Public Health and Environment, Denver, CO, USA
| | - Emily S Jentes
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Factors Influencing the Frequency of Airway Infections in Underage Refugees: A Retrospective, Cross Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186823. [PMID: 32962038 PMCID: PMC7557950 DOI: 10.3390/ijerph17186823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Abstract
Background: Infections are a leading cause of refugee morbidity. Recent data on the rate of airway infections and factors influencing their spread in refugee reception centers is scarce. Methods: A retrospective, cross-sectional study of de-identified medical records with a focus on respiratory infections in underage refugees was conducted at two large German refugee reception centers. Results: In total, medical data from n = 10,431 refugees over an observational period of n = 819 days was analyzed. Among pediatric patients (n = 4289), 55.3% presented at least once to the on-site medical ward with an acute respiratory infection or signs thereof. In 38.4% of pediatric consultations, acute airway infections or signs thereof were present. Airway infections spiked during colder months and were significantly more prevalent amongst preschool and resettled children. Their frequency displayed a positive correlation with the number of refugees housed at the reception centers. Conclusions: We show that respiratory infections are a leading cause for morbidity in young refugees and that their rate is influenced age, season, status, and residential density. This illustrates the need to protect refugee children from contracting airway infections which may also reduce the spread of coronavirus disease 2019 (COVID-19) during the current pandemic.
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