Children Adopted From Abroad Should be Retested for TB

The American Academy of Pediatrics currently recommends that all internationally adopted children be tested for tuberculosis. But repeat testing may be necessary because of a significant number of false-negatives, according to a study presented at the Pediatric Academic Societies 2005 Annual Meeting in Washington, D.C.

In research presented by Indi Trehan, MD, MPH, Linda Jaimson, RN, BSN, CIC, and Mary Allen Staat, MD, MPH, 769 internationally adopted children were seen during the 1999-2004 study period. Of these children, 71% received their first tuberculin skin test (TST) within their first two months in the US and were included in the study; 20% were reactive, 76% were non-reactive, and 4% were not read. At least three months were allowed to elapse (for incubation and detection of tuberculosis), and a repeat TST was performed in about half (203) of the patients who had initially tested negative. Of those retested, 19% had a reactive second TST.

"It's important that these children get a follow-up screening for tuberculosis three to six months after they have been in the country," Dr. Trehan said. "You can't just rely on that first TST, because you're missing about 20% of children who will have a positive reaction." He also noted that while three to six months was the range used in this study, "the ideal range has yet to be determined."

According to Dr. Staat, senior investigator, "roughly 20% to 25% of the kids that families are considering adopting are going to have tuberculosis infection." Dr. Staat noted that a large proportion of children test positive six months after arrival and, therefore, are being missed under guidelines that now recommend testing only upon arrival. (Poster Session 5479)