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School based screening for tuberculosis infection in Norway: comparison of positive tuberculin skin test with interferon-gamma release assay

Winje, Brita Askeland; Oftung, Fredrik; Korsvold, Gro Ellen; Mannsåker, Turid; Ly, Ingvild Nesthus; Harstad, Ingunn; Dyrhol-Riise, Anne Ma; Heldal, Einar
Journal article, Peer reviewed
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1471-2334-8-140.pdf (287.2Kb)
URI
http://hdl.handle.net/11250/2358276
Date
2008
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  • Institutt for samfunnsmedisin og sykepleie [1763]
  • Publikasjoner fra CRIStin - NTNU [20888]
Original version
BMC Infectious Diseases 2008, 8   10.1186/1471-2334-8-140
Abstract
Background: In Norway, screening for tuberculosis infection by tuberculin skin test (TST) has been offered for several

decades to all children in 9th grade of school, prior to BCG-vaccination. The incidence of tuberculosis in Norway is low

and infection with M. tuberculosis is considered rare. QuantiFERON®TB Gold (QFT) is a new and specific blood test for

tuberculosis infection. So far, there have been few reports of QFT used in screening of predominantly unexposed,

healthy, TST-positive children, including first and second generation immigrants. In order to evaluate the current TST

screening and BCG-vaccination programme we aimed to (1) measure the prevalence of QFT positivity among TST

positive children identified in the school based screening, and (2) measure the association between demographic and

clinical risk factors for tuberculosis infection and QFT positivity.

Methods: This cross-sectional multi-centre study was conducted during the school year 2005–6 and the TST positive

children were recruited from seven public hospitals covering rural and urban areas in Norway. Participation included a

QFT test and a questionnaire regarding demographic and clinical risk factors for latent infection. All positive QFT results

were confirmed by re-analysis of the same plasma sample. If the confirmatory test was negative the result was reported

as non-conclusive and the participant was offered a new test.

Results: Among 511 TST positive children only 9% (44) had a confirmed positive QFT result. QFT positivity was

associated with larger TST induration, origin outside Western countries and known exposure to tuberculosis. Most

children (79%) had TST reactions in the range of 6–14 mm; 5% of these were QFT positive. Discrepant results between

the tests were common even for TST reactions above 15 mm, as only 22 % had a positive QFT.

Conclusion: The results support the assumption that factors other than tuberculosis infection are widely contributing

to positive TST results in this group and indicate the improved specificity of QFT for latent tuberculosis. Our study

suggests a very low prevalence of latent tuberculosis infection among 9th grade school children in Norway. The result

will inform the discussion in Norway of the usefulness of the current TST screening and BCG-policy.
Publisher
BioMed Central
Journal
BMC Infectious Diseases

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