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  • American Academy of Pediatrics (AAP)  (4)
  • 1
    Online Resource
    Online Resource
    Risk Factors for Positive Mantoux Tuberculin Skin Tests in Children in San Diego, California: Evidence for Boosting and Possible Foodborne Transmission
    American Academy of Pediatrics (AAP) ; 2001
    In:  Pediatrics Vol. 108, No. 2 ( 2001-08-01), p. 305-310
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 108, No. 2 ( 2001-08-01), p. 305-310
    Abstract: Source case finding in San Diego, California, rarely detects the source for children with tuberculosis (TB) infection or disease. One third of all pediatric TB isolates in San Diego are Mycobacterium bovis, a strain associated with raw dairy products. This study was conducted to determine risk factors for TB infection in San Diego. Design. Case-control study of children ≤5 years old screened for TB as part of routine health care visit. Asymptomatic children with a positive (≥10 mm) Mantoux skin test (TST) were matched by age to 1 to 2 children with negative TST from the same clinic. We assessed risk factors for TB infection through parental interview and chart review. Results. A total of 62 cases and 97 controls were enrolled. Eleven cases and 25 controls were excluded from analysis because of previous positive skin tests. Compared with controls, cases were more likely to have received BCG vaccine (73% vs 7%, odds ratio [OR] 44), to be foreign born (35% vs 11%, OR 4.3), and to have eaten raw milk or cheese (21% vs 8%, OR 3.76). The median time between the most recent previous TST and the current test was 12 months for cases and 25 months for controls. Other factors associated with a positive TST included foreign travel, staying in a home while out of the country, and having a relative with a positive TST. There was no association between contact with a known TB case. In a multivariable model, receipt of BCG, contact with a relative with a positive TST, and having a previous TST within the past year were independently associated with TB infection. Conclusions. We identified several new or reemerging associations with positive TST including cross border travel, staying in a foreign home, and eating raw dairy products. The strong associations with BCG receipt and more recent previous TST may represent falsely positive reactions, booster phenomena, or may be markers for a population that is truly at greater risk for TB infection. Unlike studies conducted in nonborder areas, we found no association between positive TB skin tests and contact with a TB case or a foreign visitor. Efforts to control pediatric TB in San Diego need to address local risk factors including consumption of unpasteurized dairy products and cross-border travel. The interpretation of a positive TST in a young child in San Diego who has received BCG is problematic.
    Type of Medium: Online Resource
    ISSN: 1098-4275 , 0031-4005
    URL: Article
    DOI: 10.1542/peds.108.2.305
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2001
    detail.hit.zdb_id: 1477004-0
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  • 2
    Online Resource
    Online Resource
    Tuberculosis Transmission Among Five School Bus Drivers and Students in Two New York Counties
    American Academy of Pediatrics (AAP) ; 1997
    In:  Pediatrics Vol. 100, No. 3 ( 1997-09-01), p. e9-e9
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 100, No. 3 ( 1997-09-01), p. e9-e9
    Abstract: Objective. Between November 1994 and April 1995, more than 3300 students in 49 schools in two counties in New York were potentially exposed to five school bus drivers with tuberculosis. This investigation was carried out to determine the extent of transmission of Mycobacterium tuberculosis among students. Methods. Components of the epidemiologic investigation included tuberculin skin-test screening and collection of demographic information for students exposed to a driver with tuberculosis, chest radiography and medical evaluation of individuals with positive skin tests, and DNA fingerprinting of M tuberculosis isolates. A positive skin test was defined as ≥10 mm induration, and a converter was an individual with an increase in reaction size of ≥10 mm in the past 2 years. Results. The rates of positive skin tests were 0.8%, 0.3%, 9.9%, 1.1%, and 0.7% among US-born students exposed to drivers 1 through 5, respectively. The relative risk for a positive tuberculin skin test was significant only for students exposed to driver 3, and the only secondary case identified among students was exposed to driver 3. The DNA fingerprint patterns of isolates from drivers 3 and 4 matched. Conclusion. There was no clear evidence of transmission ofM tuberculosis to students from drivers 1, 2, 4, or 5. However, evidence suggests that driver 3 transmitted M tuberculosis to students and another driver. Routine annual tuberculin skin-test screening of drivers would not have prevented these tuberculosis exposures.
    Type of Medium: Online Resource
    ISSN: 1098-4275 , 0031-4005
    URL: Article
    DOI: 10.1542/peds.100.3.e9
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1997
    detail.hit.zdb_id: 1477004-0
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  • 3
    Online Resource
    Online Resource
    Immigration and Tuberculosis Among Children on the United States–Mexico Border, County of San Diego, California
    American Academy of Pediatrics (AAP) ; 1999
    In:  Pediatrics Vol. 104, No. 1 ( 1999-07-01), p. e8-e8
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 104, No. 1 ( 1999-07-01), p. e8-e8
    Abstract: To identify factors contributing to a 400% increase in tuberculosis among children in San Diego County, California, from 1985 to 1993. Design. Review of medical records of reported cases in 1989, 1991, and 1993 and their source case. Results. Of 192 children with tuberculosis, the largest increase was observed in children younger than 5 years old, of whom 77.4% were born in the United States, 67.8% had a foreign-born parent, 73.1% came from a non-English-speaking household, and 46.2% were known to visit Mexico. Of 28 source cases, 82.1% were born outside the United States, primarily in Mexico (67.9%). Resistance to at least one first-line antituberculous drug was identified in 27.5% of isolates from children and in 33.3% of isolates from source cases. Conclusions. The increase in tuberculosis and high level of drug-resistance among children born in the United States may be attributed to transmission outside of the United States or within the United States from household contacts born in countries in which tuberculosis is highly endemic.
    Type of Medium: Online Resource
    ISSN: 1098-4275 , 0031-4005
    URL: Article
    DOI: 10.1542/peds.104.1.e8
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1999
    detail.hit.zdb_id: 1477004-0
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  • 4
    Online Resource
    Online Resource
    Tuberculin Skin Test Screening in Schoolchildren in the United States
    American Academy of Pediatrics (AAP) ; 1996
    In:  Pediatrics Vol. 98, No. 1 ( 1996-07-01), p. 97-102
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 98, No. 1 ( 1996-07-01), p. 97-102
    Abstract: Objective. To determine the current practices and results of tuberculin skin test (TST) screening of schoolchildren in the United States. Methods. Tuberculosis program staff in all states and the District of Columbia were asked about current requirements, practices, and results of school-based TST screening. Results. Thirty-four states and the District of Columbia (69%) reported no current statewide statutes or policies for tuberculin screening of schoolchildren, and 10 (19%) reported having statewide requirements. In 6 states (12%), requirements were instituted at the local level, and 24 localities in these states were known to require screening. Of the 34 areas requiring screening, 18 (53%) screened all new entrants, 7 (21%) screened children in specific grades, and 9 (26%) used other criteria for screening. TST results were collected for 26 (76%) of 34 areas, and 6 areas collected results of follow-up evaluation of tuberculin-positive children. Additionally, 8 localities in 7 states with no screening requirements conducted tuberculin surveys. Sixteen areas provided results. In 7 of the 8 areas that collected information about birthplace, less than 2% of US-born children were tuberculin positive; foreign-born children had rates 6 to 24 times higher than US-born children. TST screening identified few cases of tuberculosis, less than 0.02% of the children screened. Conclusion. School-based tuberculin screening identified low rates of positive TST results in US-born children. Resources should be directed toward screening children at high risk for tuberculous infection, as recommended by the American Academy of Pediatrics and the Advisory Committee for Elimination of Tuberculosis.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.98.1.97
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1996
    detail.hit.zdb_id: 1477004-0
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