PEDIATRICS Vol. 108 No. 2 August 2001, pp. 305-310
Risk Factors for Positive Mantoux Tuberculin Skin Tests in Children in San Diego, California: Evidence for Boosting and Possible Foodborne Transmission
Received Jun 12, 2000; accepted Dec 18, 2000.
,,
From the * Department of Pediatrics, University of California,
San Diego School of Medicine, San Diego, California; Objectives. Source case finding in
San Diego, California, rarely detects the source for children with
tuberculosis (TB) infection or disease. One third of all pediatric TB
isolates in San Diego are Mycobacterium bovis, a strain
associated with raw dairy products. This study was conducted to
determine risk factors for TB infection in San Diego.
Design. Case-control study of children Results. A total of 62 cases and 97 controls were
enrolled. Eleven cases and 25 controls were excluded from analysis
because of previous positive skin tests. Compared with controls, cases
were more likely to have received BCG vaccine (73% vs 7%, odds ratio
[OR] 44), to be foreign born (35% vs 11%, OR 4.3), and to have
eaten raw milk or cheese (21% vs 8%, OR 3.76). The median time
between the most recent previous TST and the current test was 12 months
for cases and 25 months for controls. Other factors associated with a
positive TST included foreign travel, staying in a home while out of
the country, and having a relative with a positive TST. There was no
association between contact with a known TB case. In a multivariable
model, receipt of BCG, contact with a relative with a positive TST, and
having a previous TST within the past year were independently
associated with TB infection.
Conclusions. We identified several new or reemerging
associations with positive TST including cross border travel, staying
in a foreign home, and eating raw dairy products. The strong
associations with BCG receipt and more recent previous TST may
represent falsely positive reactions, booster phenomena, or may be
markers for a population that is truly at greater risk for TB
infection. Unlike studies conducted in nonborder areas, we found no
association between positive TB skin tests and contact with a TB case
or a foreign visitor. Efforts to control pediatric TB in San Diego need
to address local risk factors including consumption of unpasteurized dairy products and cross-border travel. The interpretation of a
positive TST in a young child in San Diego who has received BCG is
problematic.
Division of
Bacterial and Mycotic Diseases, National Center for Infectious
Diseases, and § Tuberculosis Elimination, National Center for HIV, STD,
and TB Prevention, Centers for Disease Control and Prevention, Atlanta,
Georgia.
5 years old
screened for TB as part of routine health care visit. Asymptomatic
children with a positive (
10 mm) Mantoux skin test (TST) were matched
by age to 1 to 2 children with negative TST from the same clinic. We assessed risk factors for TB infection through parental interview and
chart review.
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