title: Evaluation of QuantiFERON-TB gold in-tube and tuberculin skin tests among immigrant children being screened for latent tuberculosis infection.
abstract: BACKGROUND
  Centers for Disease Control and Prevention requirements for pre-immigration tuberculosis (TB) screening of children 2- to 14-years old permit a tuberculin skin test (TST) or an interferon-gamma release assay (IGRA). Few data are available on the performance of IGRAs versus TSTs in foreign-born children.
  
  
  METHODS
  We compared the performance of TST and QuantiFERON-TB (QFT) Gold In-Tube in children 2- to 14-years old applying to immigrate to the United States from Mexico, the Philippines and Vietnam, using diagnosis of TB in immigrating family members as a measure of potential exposure.
  
  
  RESULTS
  We enrolled 2520 children: 664 (26%) were TST+ and 142 (5.6%) were QFT+. One hundred and eleven (4.4%) were TST+/QFT+, 553 (21.9%) were TST+/QFT- and 31 (1.2%) were TST-/QFT+. Agreement between tests was poor (κ = 0.20). Although positive results of both tests were significantly associated with older age (relative risks [RR] TST+, 1.64; 95% confidence interval [CI]: 1.36-1.97; RR QFT+, 3.05; 95% CI: 1.72-5.38) and with the presence of TB in at least 1 immigrating family member (RR TST+, 1.40; 95% CI: 1.12-1.75; RR QFT+ 2.24; 95% CI: 1.18-4.28), QFT+ results were more strongly associated with both predictive variables.
  
  
  CONCLUSIONS
  The findings support the preferential use of QFT over TST for pre-immigration screening of foreign-born children 2 years of age and older and lend support to the preferential use of IGRAs in testing foreign-born children for latent TB infection.
authors.affiliation: From the *Centers for Disease Control and Prevention, Atlanta, GA; †Methodist Hospital Research Institute, Houston, TX; and ‡Denver Health and Hospital Authority, Denver, CO.
authors.forename: Meredith M
authors.initials: MM
authors.lastname: Howley
authors.forename: John A
authors.initials: JA
authors.lastname: Painter
authors.forename: Dolores J
authors.initials: DJ
authors.lastname: Katz
authors.forename: Edward A
authors.initials: EA
authors.lastname: Graviss
authors.forename: Randall
authors.initials: R
authors.lastname: Reves
authors.forename: Suzanne F
authors.initials: SF
authors.lastname: Beavers
authors.forename: Denise O
authors.initials: DO
authors.lastname: Garrett
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D059425:Interferon-gamma Release Tests / Q000379:methods*; D055985:Latent Tuberculosis / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011446:Prospective Studies; D012882:Skin Tests / Q000379:methods; D014374:Tuberculin Test / Q000379:methods*; D014481:United States
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