CHILDREN FOR WHOM IMMEDIATE SKIN TESTING IS INDICATED:
- Contacts of persons with confirmed or suspected infectious tuberculosis (contact investigation); this includes children identified as contacts of family members or associates in jail or prison in the last five years.
- Children with radiographic or clinical findings suggesting tuberculosis.
- Children immigrating from endemic countries (e.g., Asian, Middle Eastern, African, or Latin American countries)
- Children with travel histories to endemic countries and/or significant contact with indigenous persons from such countries.
CHILDREN WHO SHOULD BE TESTED ANNUALLY FOR TUBERCULOSIS:
- Children infected with HIV or living in household with HIV-infected persons.
CHILDREN WHO SHOULD BE TESTED EVERY 2-3 YEARS:
- Children exposed to the following individuals: HIV infected, homeless, residents of nursing homes, institutionalized adolescents or adults, users of illicit drugs, incarcerated adolescents or adults and migrant farm workers.
- Foster children with exposure to adults in the preceeding high-risk groups are included.
CHILDREN WHO SHOULD BE CONSIDERED FOR TUBERCULIN SKIN TESTING AT AGES 4-6 AND11-16 YEARS:
- Children whose parents immigrated (with unknown tuberculin skin test status) from regions of the world with high prevalence of tuberculosis. Continued potential exposure by travel to the endemic areas, and/or household contact with persons from the endemic areas (with unknown tuberculin skin test status), should be an indication for repeat tuberculin skin testing.
- Children without specific risk factors, who reside in high-prevalence areas. In general, a high-risk neighborhood or community does not mean an entire city is at high risk. Rates in any area of the city may vary by neighborhood, or even from block to block. Physicians should be aware of these patterns in determining the likelihood of exposure. Public health officials or local tuberculosis experts should help clinicians identify areas that have appreciable tuberculosis rates.
CHILDREN AT INCREASED RISK OF PROGRESSION OF INFECTION TO DISEASE:
Those with other medical risk factors, including diabetes mellitus, chronic renal failure, malnutrition, and congenital or acquired immunodeficiencies deserve special consideration. Without recent exposure, these person are not at increased risk of acquiring tuberculosis infection. Underlying immune deficiencies asociated with these conditions theoretically would enhance the possibility for progression to severe disease.
Initial histories of potential exposure to tuberculosis should be included on all of these patients. If these histories, or local epidemilogic factors, suggest a possibility of exposure, immediate and periodic tuberculin skin testing should be considered.
An initial Mantoux tuberculin skin test should be performed before initiation of immunosuppressive therapy in any child with an underlying condition that necessitates immunosuppressive therapy.
1997 Red Book - Report of the Committee on Infectious Diseases (24th Ed.)