Screening for TB in high school adolescents in a high burden setting in South Africa - 25/09/13

Doi : 10.1016/j.tube.2013.02.007

Hassan Mahomed ^a,^b,^e,^⁎ , Rodney Ehrlich ^c,^e , Tony Hawkridge ^b,^d,^e , Mark Hatherill ^a,^b,^e , Lawrence Geiter ^f,^{^{i
Employed by the Aeras Foundation at the time of this study.}} , Fazlin Kafaar ^a,^b,^e , Deborah Ann Abrahams ^a,^b,^e , Humphrey Mulenga ^a,^b,^e , Michele Tameris ^a,^b,^e , Hennie Geldenhuys ^a,^b,^e , Willem Albert Hanekom ^a,^b,^e , Suzanne Verver ^g,^h,^{^{j
Honorary research associate, University of Cape Town.}} , Gregory Dudley Hussey ^b,^d,^e
^a South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
^b School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
^c School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
^d Vaccines for Africa Initiative, University of Cape Town, Cape Town, South Africa
^e University of Cape Town, Cape Town, South Africa
^f Otsuka Pharmaceutical Development and Commercialization, Inc., Rockville, MD, USA
^g KNCV Tuberculosis Foundation, The Hague, The Netherlands
^h CINIMA, Academic Medical Centre, Amsterdam, The Netherlands

Corresponding author. South African Tuberculosis Vaccine Initiative, Institute of Infectious Disease and Molecular Medicine, 11 Chudleigh Road, Plumstead, Cape Town 7925, South Africa. Tel.: +27 82 334 5763 (mob); fax: +27 21 406 6081.

Summary

Screening for tuberculosis (TB) disease is important for TB control and TB vaccine efficacy trials but this has not been evaluated in adolescents. We conducted a study to determine the prevalence of active TB and performance of specific screening tests for TB in adolescents in a high burden setting. Adolescents aged 12–18 years were recruited from high schools in a rural town in South Africa. Participants were screened for active TB using symptoms, household TB contact, positive interferon gamma release assay (IGRA) and positive tuberculin skin test (TST). Of 6363 adolescents recruited, 21 were newly diagnosed with TB of whom 19 were culture positive. After exclusions, the derived prevalence of smear positive TB was 16/5682 = 3/1000 (95% confidence interval (CI) 1–4/1000). The sensitivity of TST and IGRA for active TB were 85% (95% CI 62–100%) and 94% (95% CI 79–100%) respectively. None of the methods alone or in combination had positive predictive values greater than 2%. The screening tools evaluated in this study may not be practical for routine use owing to low positive predictive values but may be useful in TB vaccine clinical trials.

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Keywords : Tuberculosis, Adolescence, Prevalence, Screening

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Sensitivity, specificity, positive predictive value and negative predictive value

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Vol 93 - N° 3

P. 357-362 - mai 2013 Retour au numéro

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Screening for TB in high school adolescents in a high burden setting in South Africa - 25/09/13

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