OUTCOMES OF ANNUAL TUBERCULOSIS SCREENING BY MANTOUX TEST IN CHILDRENCONSIDERED TO BE AT HIGH-RISK - RESULTS FROM ONE URBAN CLINIC

Background. in January 1994, the American Academy of Pediatrics recomm ended that annual screening with the purified protein derivative tuber culin skin test, Mantoux method, be used for tuberculosis screening in high-risk children. This test has a better sensitivity and specificit y than the previously used multiple puncture test, and patients need t o return for a reading done by palpation by a health care professional . Objective. To estimate the prevalence of reactivity to purified prot ein derivative tuberculin in an urban primary care clinic whose patien ts meet high-risk criteria and to determine if annual screening is war ranted, to determine the adherence to return to the clinic for reading of the skin test, and to describe the characteristics of patients who have tuberculosis infection and disease. Research Design. Cross-secti onal study. Setting. Inner-city, hospital-based primary care pediatric clinic in Baltimore, MD. Subjects. A total of 1433 consecutive childr en attending this clinic from March through September, 1994, who were at risk for tuberculosis because of frequent exposure to poor and medi cally indigent city dwellers. Methods. The Mantoux test (5TU intraderm al injection of purified protein derivative) was administered to child ren at annual health supervision visits. Patients were tracked to dete rmine those who returned for a reading by a health care professional a nd find those with a positive Mantoux test. The charts of children wit h a positive test were reviewed. Results. Five hundred seventy-three ( 40%) patients returned for a reading by a health care professional. Fi ve patients had a positive Mantoux test, giving a prevalence rate of 0 .8% of reactivity to purified protein derivative tuberculin. One child with a positive Mantoux test also had chest radiograph findings consi stent with tuberculosis disease but was asymptomatic. Conclusions. In our city with a low prevalence of disease, children whose only risk fa ctor for tuberculosis was exposure to poor and medically indigent city dwellers did not represent a high-risk group. Our results are support ive of the 1996 American Academy of Pediatrics screening statement tha t annual screening is not warranted. Sixty percent of children did not return for a reading of the Mantoux test by a health care professiona l. Alternative strategies that are more convenient for parents are nee ded to obtain accurate readings by health care professionals when skin testing is deemed necessary.