PT  - JOURNAL ARTICLE
AU  - Catherine Yang
AU  - Abdool S. Yasseen III
AU  - Jennifer Stimec
AU  - Elizabeth Rea
AU  - Valerie Waters
AU  - Ray Lam
AU  - Shaun K. Morris
AU  - Ian Kitai
TI  - Prevalence of tuberculosis infection and disease in children referred for tuberculosis medical surveillance in Ontario: a single-cohort study
AID  - 10.9778/cmajo.20180043
DP  - 2018 Jul 01
TA  - CMAJ Open
PG  - E365--E371
VI  - 6
IP  - 3
4099  - http://www.cmajopen.ca/content/6/3/E365.short
4100  - http://www.cmajopen.ca/content/6/3/E365.full
SO  - CMAJ2018 Jul 01; 6
AB  - Background: There are few data about the utility of the Canadian tuberculosis medical surveillance system for detecting tuberculosis in children and adolescents. We sought to assess the prevalence of tuberculosis infection and disease in children and adolescents referred by the tuberculosis medical surveillance program who were evaluated at The Hospital for Sick Children (SickKids) tuberculosis program.Methods: We retrospectively studied clinical records, radiographic findings and results of interferon-γ release assays (IGRAs) of all children less than 18 years of age referred by the tuberculosis medical surveillance program and evaluated at SickKids between November 2012 and June 2016.Results: The median age of the 216 children was 10.0 years. Most were born in the Philippines (157 [72.7%]) or India (39 [18.0%]). Of the 216, 166 (76.8%) had a history of prior treatment for tuberculosis, and 34 (15.7%) were federal-sponsored refugees from settings with a high tuberculosis burden. Negative IGRA results were found in 110/130 (84.6%) of those with prior tuberculosis treatment. Thirty-one children (14.4%) had any chest radiographic abnormality, of whom 4 had changes thought to be due to tuberculosis. No child received a diagnosis of active tuberculosis at assessment or during follow-up; 3 (1.4%) were treated for latent tuberculosis infection following IGRA testing at SickKids. A positive IGRA result was associated with contact with infectious tuberculosis (odds ratio [OR] 5.97, 95% confidence interval [CI] 2.06–17.52) and older age at first clinic visit (OR 2.98, 95% CI 1.24–8.30) but not with radiographic abnormalities or history of prior tuberculosis treatment.Interpretation: Most children were referred because of a history of prior treatment for tuberculosis; few had clinical or laboratory evidence of infection or prior disease. The tuberculosis medical surveillance process did not identify any children who required treatment for active disease and requires improvement.