Tuberculosis in children

•Based on research evidence and consensus, newly diagnosed tuberculosis (TB) infections in children are sentinel events that indicate recent transmission of Mycobacterium tuberculosis (Mtb) and require prompt investigation for the source TB case. (24) • Based on research evidence and consensus, screening for TB infection should be performed only in children with risk factors for TB (including birth, travel, or previous residence outside of the United States, and close contact with an individual with infectious TB) using a questionnaire. (24) • Based on strong research evidence, interferon-g release assays (IGRAs) have several advantages over the tuberculin skin test (TST), including higher specificity and lower likelihood of false-positive results due to previous Bacille Calmette-Guérin vaccination or nontuberculous mycobacteria infection. (23) • Due to insufficient evidence, the youngest age at which IGRAs are reliable is not clear. The American Thoracic Society/Centers for Disease Control and Prevention (CDC)/Infectious Diseases Society of America consensus guidelines favor use of the TST rather than IGRAs in children younger than 5 years. (23) However, the American Academy of Pediatrics recommends the use of IGRAs in children as young as 2 years old in some circumstances. (28) The TST remains the preferred strategy to evaluate children younger than 2 years for TB infection due to limited data regarding the use of IGRAs in this age group. • Based on research evidence and consensus, children younger than 4 years and those who are immunocompromised are at high risk for progression from TB infection to TB disease, and if exposed to an individual with infectious TB require “window prophylaxis,” usually with isoniazid (INH), even if initial TST or IGRA test results are negative. • Based on strong research evidence, a shorter (3-month) treatment regimen for latent TB infection in children older than 2 years and using once weekly INH and rifapentine administered via directly observed therapy has high rates of efficacy and adherence. (56) • Based on research evidence and consensus, treatment of TB disease in children requires multidrug therapy for a minimum of 6 months, depending on the site of infection and drug susceptibility of the Mtb isolate. Treatment for TB should be provided via directly observed therapy through local or state public health departments. (52).