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Retesting Adopted Children for Tuberculosis

Repeat TB testing is necessary for internationally adopted children.

For internationally adopted children who come to the U.S., is retesting necessary for those whose initial tuberculin skin tests (TSTs) are negative? To find out, investigators evaluated 527 such children (mean age, 23 months); most were adopted from Russia, China, or Guatemala.

On initial testing within 2 months of arrival, 416 children (79%) had negative TSTs, and 111 children (21%) had positive TSTs (10 mm induration). None of the children with positive tests had evidence of active tuberculosis (TB) infection. Of 204 children with initial negative results who were retested at least 3 months after their initial tests, 191 were read within 48 to 72 hours, and 38 were positive; again, none had active TB infections. Presence of a bacille Calmette-Guérin (BCG) immunization scar and better nutritional status (assessed by weight for age) were related significantly to a positive TST result on initial testing. Improved nutritional status also was associated with a positive TST result on repeat testing.

Comment: Even if we assume negative results for all children who were not retested and for those whose tests were not read within 48 to 72 hours, the positive rate at retesting would be 9% (38 of 416). The authors speculate that improved nutrition after coming to the U.S., with reversal of anergy, might account for some of the positive retest results. Although some positive tests might represent reactions to BCG, these data indicate clearly that repeat testing for TB is necessary in internationally adopted children.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine July 23, 2008

Citation(s):

Trehan I et al. Tuberculosis screening in internationally adopted children: The need for initial and repeat testing. Pediatrics 2008 Jul; 122:e7. (http://dx.doi.org/10.1542/peds.2007-1338)

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