title: European shortage of purified protein derivative and its impact on tuberculosis screening practices.
abstract: In June 2014, we became aware that shortages of purified protein derivative (PPD), the test substance used for the tuberculin skin test (TST), had occurred in several European health care institutions providing care for children with tuberculosis (TB).
  
  
  
  To establish the extent of the shortage, a survey was performed.
  
  
  
  Survey conducted over a 1-month period (June-July 2014) among members of the Paediatric Tuberculosis Network European Trials Group (ptbnet).
  
  
  
  Thirty-five physicians from 23 European countries contributed data. The most commonly used PPD product was RT23 (Statens Serum Institut; n = 22, 63%). Twenty-one (60%) participants reported that their institution was experiencing a PPD shortage. The majority (n = 17, 81%) of those reporting a shortage were using RT23. Thirteen (37%) participants reported changes in screening practices resulting from the shortage, including sourcing PPD from alternative manufacturers, restricting remaining supplies to patients at greatest risk or replacing TST by an interferon-gamma release assay.
  
  
  
  The data show that a PPD shortage occurred in 2014, affecting multiple European countries. The shortage resulted in changes in TB screening capabilities and practices, potentially compromising both patient care as well as public health efforts. Appropriate actions to prevent future PPD shortages should be explored urgently by public health agencies and key stakeholders.
authors.affiliation: Academic Unit of Clinical & Experimental Sciences, Faculty of Medicine and Institute for Life Sciences and Global Health Research Institute, University of Southampton, Southampton, UK; Department of Paediatric Infectious Diseases & Immunology and Southampton National Institute for Health Research Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Tebruegge
authors.affiliation: Department of Paediatrics, Catholic University of Rome, A Gemelli Hospital, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Buonsenso
authors.affiliation: Department of Paediatric Pneumology, Ruhr-University, Bochum, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Brinkmann
authors.affiliation: Infectious Diseases Unit, Department of Paediatrics, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Noguera-Julian
authors.affiliation: Department of Paediatric Allergology, Pulmonology, Rheumatology and Clinical Immunology, Children's Hospital Zagreb, Zagreb, Croatia.
authors.forename: I
authors.initials: I
authors.lastname: Pavić
authors.affiliation: Clinic of Pulmonary Diseases, Iasi, Romania.
authors.forename: A Sorete
authors.initials: AS
authors.lastname: Arbore
authors.affiliation: Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
authors.forename: Z
authors.initials: Z
authors.lastname: Vančíková
authors.affiliation: Department of Pulmonary Diseases, Clinic of Pulmonary Diseases in Children, Medical University Sofia, Sofia, Bulgaria.
authors.forename: S
authors.initials: S
authors.lastname: Velizarova
authors.affiliation: Birmingham Chest Clinic, Heart of England NHS Foundation Trust, Birmingham, UK.
authors.forename: S B
authors.initials: SB
authors.lastname: Welch
authors.affiliation: Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology, Basel, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Ritz
mesh_terms: D005060:Europe; D006301:Health Services Needs and Demand; D006801:Humans; D059425:Interferon-gamma Release Tests; D008403:Mass Screening; D015995:Prevalence; D014373:Tuberculin; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis*
chemical_list: D014373:Tuberculin