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Use of Interferon Gamma Release Assays in Children <2 Years Old.
Journal of the Pediatric Infectious Diseases Society 2023 July 22
While interferon gamma release assays (IGRA) are widely used for detecting tuberculosis infection, tuberculin skin tests (TST) remain preferred for children under the age of 2 years. The preference for TST stems from concern over IGRA sensitivity in young children. However, TSTs are susceptible to false positive results following Bacille Calmette-Guérin (BCG) vaccination which is common in infancy, and exposure to nontuberculous mycobacteria. We reviewed available data for IGRA performance in children under age 2 years. Across four cohorts of high-risk children under age 2 (mostly case contacts or those born in tuberculosis endemic regions), 0 of 575 untreated children with negative IGRA test results progressed to tuberculosis disease - including 0 of 70 who were TST positive but IGRA negative. While neither TST nor IGRA are perfectly sensitive for diagnosis of tuberculosis infection, IGRAs are an acceptable alternative to TST in children <2 years of age.
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