The tuberculin skin test in a healthy child program: should we change our practice

• Published in: Anales de pediatría (Barcelona, Spain : 2003) Vol. 65; no. 3; pp. 225 - 228
• Main Authors: Espinosa Arévalo, M, Vázquez Gallardo, R, Gayoso Diz, P
• Format: Journal Article
• Language: Spanish
• Published: Spain 01-09-2006
• Subjects: Adolescent; Child; Child Health Services; Child, Preschool; Humans; Infant; Program Evaluation; Prospective Studies; Tuberculin Test
• ISSN: 1695-4033

The Healthy Child Program and the Preventive Activities and Health Promotion Program involve systematic tuberculin skin testing at distinct ages according to different programs, with variable evaluation of its effectiveness.
To evaluate the tuberculin skin test performed in healthy children within the ongoing basic health program in order to determine whether our activity is effective in detecting latent tuberculin infection.
A prospective observational study was performed.
Mantoux test performed in children aged 15 months to 14 years during regular health examinations in 22 primary care pediatric clinics over a 12-month period in southern Pontevedra in Spain (catchment population 300,613 inhabitants according to the official census data in January 2003, with 472,444 health cards). Descriptive study and univariate analysis were carried out.
We studied 2,530 children with a mean age of 51.25 months (95 % CI: 49.38-53.13). Eight positive Mantoux tests were registered (0.36 %). There were three positive results in children aged less than 3 years, two positive results in children aged between 4 and 9 years old (all were immigrants) and the remaining positive results were registered in children between 10 and 14 years of age.
Given that the tuberculin skin test is a good screening test despite its limitations in the control of latent tuberculin infection in children, its indications should be adjusted to ever-changing epidemiological characteristics. According to the results obtained in this study and considering the prevalence of tuberculosis in our environment, we propose that the systematic application of the Mantoux test be discontinued except in children from countries with a high incidence of this disease or risk factors. However, we also recommend that systematic Mantoux testing in adolescence (12-14 years of age) be maintained, when vaccination and various medical examinations are carried out. Epidemiological studies in this age group should simultaneously be performed.