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Abstract
Background NICE Tuberculosis (TB) guideline 2015 recommends all children, regardless of BCG status, with Mantoux ≥ 5mm induration receive treatment for latent TB once active TB has been excluded. The 2011 version defines a positive Mantoux as ≥ 6mm (no prior BCG) and ≥ 15mm (prior BCG). NICE 2011 recommends screening of household contacts of all cases of TB compared with the 2015 guideline which recommends screening of contacts of pulmonary TB only.
Objectives To establish the impact of the change in NICE recommendations on the number of children assessed and treated for latent TB infection (LTBI) or TB disease in our department.
Methods We performed a retrospective analysis of all children < 16 years referred for contact tracing, new entrant screening or medical assessment who had a Mantoux between January and December 2014. Nurse assessment was followed by specialist consultant review in all infants ≤ 2 years and children with symptoms or Mantoux ≥ 10mm. Medical notes, Mantoux and BCG status categorised those who would have been treated according to the 2011 and 2015 NICE TB guidelines.
Results 445 patients were referred, 75 with symptoms, 138 new entrants, 63 non-pulmonary contacts and 169 pulmonary contacts.
Of those with symptoms, 5 had positive Mantoux (NICE 2011) compared with 18 (NICE 2015). In this group 0/75 were treated for LTBI and 7/75 for TB disease.
Results of patients referred for contact tracing/new entrant screening are shown in Table 1. Two contacts with LTBI and 1 with TB disease (all IGRA positive) would have been missed by the 2011 guideline but identified in 2015.
Following NICE 2015 63 non-pulmonary contacts would not have been seen. None of these had LTBI or TB disease. Of the remaining 307 contacts/new entrants 47(15%) had a positive Mantoux of whom 11(4%) had LTBI and 4(1%) TB disease.
Results of Mantoux testing and TB disease status in patients referred for contract tracing or new entrant screening
Conclusion 37% more children will be investigated and treated for TB infection/disease under the new NICE TB guideline. In a 12 month period in our clinic this represents 33 additional children with 1 extra case of TB disease and 2 cases of LTBI identified.