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. 2020 Aug;26(8):1686-1694.
doi: 10.3201/eid2608.190793.

Tuberculosis in Internationally Displaced Children Resettling in Harris County, Texas, USA, 2010-20151

Gabriella S Lamb, Andrea T Cruz, Elizabeth A Camp, Michelle Javier, Jessica Montour, Tamisha Piper, Umair A Shah, Jeffrey R Starke

Tuberculosis in Internationally Displaced Children Resettling in Harris County, Texas, USA, 2010-20151

Gabriella S Lamb et al. Emerg Infect Dis. 2020 Aug.

Abstract

US guidelines have recommended testing children emigrating from high tuberculosis-incidence countries with interferon-gamma release assays (IGRAs) or tuberculin skin tests (TSTs). We describe the Harris County (Texas) Public Health Refugee Health Screening Program's testing results during 2010-2015 for children <18 years of age: 5,990 were evaluated, and 5,870 (98%) were tested. Overall, 364 (6.2%) children had >1 positive test: 143/1,842 (7.8%) were tested with TST alone, 129/3,730 (3.5%) with IGRA alone, and 92/298 (30.9%) with both TST and IGRA. Region of origin and younger age were associated with positive TST or IGRA results. All children were more likely to have positive results for TST than for IGRA (OR 2.92, 95% CI 2.37-3.59). Discordant test results were common (20%) and most often were TST+/IGRA- (95.0%), likely because of bacillus Calmette-Guérin vaccination. Finding fewer false positives supports the 2018 change in US immigration guidelines that recommends using IGRAs for recently immigrated children.

Keywords: Texas; United States; asylee; bacteria; children; epidemiology; interferon-gamma release assay; internationally displaced; refugee; tuberculin skin test; tuberculosis and other mycobacteria.

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Figures

Figure 1
Figure 1
Consort diagram of TST and IGRA results in internationally displaced children over a 6-year period, Harris County, Texas, USA, 2010–2015. The percentage reported for TB disease, infection, and uninfected are the percentage of persons who had ≥1 positive test. IGRA, interferon gamma release assay; TST, tuberculin skin test; TB, tuberculosis; +, positive; –, negative.
Figure 2
Figure 2
Comparison of TST and IGRA results (using IGRAs as reference) in internationally displaced children over a 6-year period, Harris County, Texas, USA, 2010–2015. A) By location; B) by age. Brackets indicate ORs and 95% CIs between categories. IGRA, interferon gamma release assay; OR, odds ratio; TST, tuberculin skin test.
See this image and copyright information in PMC

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