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Proposal to Revise the Screening Test for Latent Tuberculosis Infection in Close Contacts at Elementary Schools in Korea

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초록

The 2018 National Guideline for Tuberculosis Control, which was published by the Korea Centers for Diseases Prevention and Control (KCDC), mandates conducting an epidemiological survey among close contacts of active tuberculosis patients at public institutions such as schools. In the procedure for these surveys, the tuberculin skin test (TST) is mandated as the screening test for latent tuberculosis infection in elementary school students. However, several guidelines recommend using the interferon-gamma releasing assay (IGRA) for contacts aged over 5 years with a Bacillus Calmette–Guérin vaccination history. The main reason for this is that IGRA has a higher specificity and lower false positive rate than TST. In addition, IGRA requires only a single visit to draw blood and the results are available within 24 hours. These advantages could promote cooperation from both parents and students in conducting these surveys. Thus, these findings regarding the benefits of IGRA for surveys of close contacts at elementary schools should be incorporated into the KCDC guideline.

Abstract

The 2018 National Guideline for Tuberculosis Control, which was published by the Korea Centers for Diseases Prevention and Control (KCDC), mandates conducting an epidemiological survey among close contacts of active tuberculosis patients at public institutions such as schools. In the procedure for these surveys, the tuberculin skin test (TST) is mandated as the screening test for latent tuberculosis infection in elementary school students. However, several guidelines recommend using the interferon-gamma releasing assay (IGRA) for contacts aged over 5 years with a Bacillus Calmette–Guérin vaccination history. The main reason for this is that IGRA has a higher specificity and lower false positive rate than TST. In addition, IGRA requires only a single visit to draw blood and the results are available within 24 hours. These advantages could promote cooperation from both parents and students in conducting these surveys. Thus, these findings regarding the benefits of IGRA for surveys of close contacts at elementary schools should be incorporated into the KCDC guideline.

참고문헌 (10)

  1. "National guideline for tuberculosis control" (2018)[URL]
  2. Chawla H, "Predictors for a positive QuantiFERON-TB-Gold test in BCG-vaccinated adults with a positive tuberculin skin test", J Infect Public Health, 5(6), pp.369~373 (2012)
  3. Kitai I, "Diagnosis and management of pediatric tuberculosis in Canada", CMAJ, 189(1), pp.E11~E16 (2017)
  4. Hartman-Adams H, "Update on latent tuberculosis infection", Am Fam Physician, 89(11), pp.889~896 (2014)
  5. "A to Z of latent tuberculosis infection"[URL]
  6. "News: students were tested after teachers" (2018)[URL]
  7. Starke JR, "Interferon-γ release assays for diagnosis of tuberculosis infection and disease in children", Pediatrics, 134(6), pp.e1763~e1773 (2014)
  8. Diel R, "Predictive value of inter-feron-γ release assays and tuberculin skin testing for progression from latent TB infection to disease state : a meta-analysis", Chest, 142(1), pp.63~75 (2012)
  9. Moon HW, "Interferon-gamma release assays for the diagnosis of latent tuberculosis infection : an updated review", Ann Clin Lab Sci, 43(2), pp.221~229 (2013)
  10. Soysal A, "Comparison of positive tuberculin skin test with an interferon-gamma-based assay in unexposed children", Jpn J Infect Dis, 61(3), pp.192~195 (2008)

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