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In Germany, the incidence of tuberculosis (TB) in children has been on the rise since 2009. High numbers of foreign-born asylum seekers have contributed considerably to the disease burden. Therefore, effective screening strategies for latent TB infection (LTBI) and active TB in asylum seeking children are needed. Our aim was to investigate the prevalence of LTBI and active TB in asylum seeking children up to 15 years of age in two geographic regions in Germany. Screening for TB was performed in children in asylum seeker reception centres by tuberculin skin test (TST) or interferon gamma release assay (IGRA). Children with positive results were evaluated for active TB. Additionally, country of origin, sex, travel time, TB symptoms, TB contact and Bacille Calmette-Guérin (BCG) vaccination status were registered. Of 968 screened children 66 (6.8%) had TB infection (58 LTBI, 8 active TB). LTBI prevalence was similar in children from high (Afghanistan) and low (Syria) incidence countries (8.7% vs 6.4%). There were no differences regarding sex, age or travel time between infected and non-infected children. Children under the age of 6 years were at higher risk of progression to active TB (19% vs 2% respectively, p=0,07). Most children (7/8) with active TB were asymptomatic at the time of diagnosis. None of the children had been knowingly exposed to TB. Asylum seeking children from high and low incidence countries are both at risk of developing LTBI or active TB. Universal TB screening for all asylum seeking children should be considered.


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  1. Bundesamt für Migration und Flüchtlinge (BAMF). [Migration Report 2015 S 9-10.As of December 2016]. 2016. German. Available from: http://www.bamf.de/SharedDocs/Anlagen/DE/Publikationen/Migrationsberichte/migrationsbericht-2015.pdf?__blob=publicationFile
  2. Brodhun B, Altmann D, Hauer B. [Report on the epidemiology of tuberculosis in Germany for 2015]. Berlin: Robert Koch Institut; 2016 German. Available from: https://www.rki.de/DE/Content/InfAZ/T/Tuberkulose/Download/TB2015.pdf;jsessionid=79CFDA71832AE18890A8273D33FAC506.1_cid390?__blob=publicationFile
  3. Fiebig L, Hauer B, Brodhun B, Altmann D, Haas W. Tuberculosis in Germany: a declining trend coming to an end? Eur Respir J. 2016;47(2):667-70.  https://doi.org/10.1183/13993003.01410-2015  PMID: 26493803 
  4. Cookson ST, Abaza H, Clarke KR, Burton A, Sabrah NA, Rumman KA, et al. "Impact of and response to increased tuberculosis prevalence among Syrian refugees compared with Jordanian tuberculosis prevalence: case study of a tuberculosis public health strategy". Confl Health. 2015;9(1):18.  https://doi.org/10.1186/s13031-015-0044-7  PMID: 26078784 
  5. [Law on the prevention and control of infectious diseases in humans]. (Infektionsschutzgesetz - IfSG), (2015). German. Available from: https://www.gesetze-im-internet.de/ifsg/IfSG.pdf
  6. Schaberg T, Bauer T, Brinkmann F, Diel R, Feiterna-Sperling C, Haas W, et al. [Tuberculosis Guideline for Adults - Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP)]. Pneumologie. 2017;71(6):325-97. PMID: 28651293 
  7. Heymann SJ, Brewer TF, Wilson ME, Colditz GA, Fineberg HV. Pediatric tuberculosis: what needs to be done to decrease morbidity and mortality. Pediatrics. 2000;106(1):E1.  https://doi.org/10.1542/peds.106.1.e1  PMID: 10878170 
  8. Morrison J, Pai M, Hopewell PC. Tuberculosis and latent tuberculosis infection in close contacts of people with pulmonary tuberculosis in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Infect Dis. 2008;8(6):359-68.  https://doi.org/10.1016/S1473-3099(08)70071-9  PMID: 18450516 
  9. Rutherford ME, Hill PC, Triasih R, Sinfield R, van Crevel R, Graham SM. Preventive therapy in children exposed to Mycobacterium tuberculosis: problems and solutions. Trop Med Int Health. 2012;17(10):1264-73.  https://doi.org/10.1111/j.1365-3156.2012.03053.x  PMID: 22862994 
  10. Dara M, Solovic I, Sotgiu G, D’Ambrosio L, Centis R, Tran R, et al. Tuberculosis care among refugees arriving in Europe: a ERS/WHO Europe Region survey of current practices. Eur Respir J. 2016;48(3):808-17.  https://doi.org/10.1183/13993003.00840-2016  PMID: 27492827 
  11. Tamashiro VG, Perez HH, Griffin DE. Prospective study of the magnitude and duration of changes in tuberculin reactivity during uncomplicated and complicated measles. Pediatr Infect Dis J. 1987;6(5):451-4.  https://doi.org/10.1097/00006454-198705000-00007  PMID: 3601492 
  12. Ritz N, Brinkmann F. [Consensus based guideline “Tuberculosis Screening in asylum seeking children and teenagers under the age of 15” under direction of the German Society for Pediatric Infectiology (DGPI)]. Monatszeitschrift für Kinderheilkunde. 2015;163(12).
  13. Spyridis NP, Spyridis PG, Gelesme A, Sypsa V, Valianatou M, Metsou F, et al. The effectiveness of a 9-month regimen of isoniazid alone versus 3- and 4-month regimens of isoniazid plus rifampin for treatment of latent tuberculosis infection in children: results of an 11-year randomized study. Clin Infect Dis. 2007;45(6):715-22.  https://doi.org/10.1086/520983  PMID: 17712755 
  14. Marais BJ, Gie RP, Schaaf HS, Hesseling AC, Obihara CC, Starke JJ, et al. The natural history of childhood intra-thoracic tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung Dis. 2004;8(4):392-402. PMID: 15141729 
  15. Sloot R, Schim van der Loeff MF, Kouw PM, Borgdorff MW. Risk of tuberculosis after recent exposure. A 10-year follow-up study of contacts in Amsterdam. Am J Respir Crit Care Med. 2014;190(9):1044-52.  https://doi.org/10.1164/rccm.201406-1159OC  PMID: 25265362 
  16. Piccini P, Chiappini E, Tortoli E, de Martino M, Galli L. Clinical peculiarities of tuberculosis. BMC Infect Dis. 2014;14(Suppl 1):S4.  https://doi.org/10.1186/1471-2334-14-S1-S4  PMID: 24564419 
  17. Beggs CB, Noakes CJ, Sleigh PA, Fletcher LA, Siddiqi K. The transmission of tuberculosis in confined spaces: an analytical review of alternative epidemiological models. Int J Tuberc Lung Dis. 2003;7(11):1015-26. PMID: 14598959 
  18. Blount RJ, Tran MC, Everett CK, Cattamanchi A, Metcalfe JZ, Connor D, et al. Tuberculosis progression rates in U.S. Immigrants following screening with interferon-gamma release assays. BMC Public Health. 2016;16(1):875.  https://doi.org/10.1186/s12889-016-3519-6  PMID: 27558397 
  19. Lönnroth K, Mor Z, Erkens C, Bruchfeld J, Nathavitharana RR, van der Werf MJ, et al. Tuberculosis in migrants in low-incidence countries: epidemiology and intervention entry points. Int J Tuberc Lung Dis. 2017;21(6):624-37.  https://doi.org/10.5588/ijtld.16.0845  PMID: 28482956 
  20. Graham SM, Ahmed T, Amanullah F, Browning R, Cardenas V, Casenghi M, et al. Evaluation of tuberculosis diagnostics in children: 1. Proposed clinical case definitions for classification of intrathoracic tuberculosis disease. Consensus from an expert panel. J Infect Dis. 2012;205(Suppl 2):S199-208.  https://doi.org/10.1093/infdis/jis008  PMID: 22448023 
  21. World Health Organization (WHO). Global tuberculosis report 2016. World Health Organization, Geneva; 2016. Available from: http://apps.who.int/medicinedocs/documents/s23098en/s23098en.pdf
  22. Cuevas LE, Petrucci R, Swaminathan S. Tuberculosis diagnostics for children in high-burden countries: what is available and what is needed. Paediatr Int Child Health. 2012;32(sup2) Suppl 2;S30-7.  https://doi.org/10.1179/2046904712Z.00000000076  PMID: 23394756 
  23. Marais BJ, Gie RP, Hesseling AC, Schaaf HS, Enarson DA, Beyers N. Radiographic signs and symptoms in children treated for tuberculosis: possible implications for symptom-based screening in resource-limited settings. Pediatr Infect Dis J. 2006;25(3):237-40.  https://doi.org/10.1097/01.inf.0000202140.76368.74  PMID: 16511386 
  24. Frigati L, Maskew M, Workman L, Munro J, Andronikou S, Nicol MP, et al. Clinical Predictors of Culture-confirmed Pulmonary Tuberculosis in Children in a High Tuberculosis and HIV Prevalence Area. Pediatr Infect Dis J. 2015;34(9):e206-10.  https://doi.org/10.1097/INF.0000000000000792  PMID: 26376315 
  25. Bozorgmehr K, Nöst S, Thaiss HM, Razum O. [Health care provisions for asylum-seekers : A nationwide survey of public health authorities in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2016;59(5):545-55.  https://doi.org/10.1007/s00103-016-2329-4  PMID: 27072501 
  26. Klinkhammer G, Korzilius H. Flüchtlinge: Gut versorgt- dank großer Hilfsbereitschaft. German. Dtsch Arztebl. 2015;41(112).
  27. de Vries SG, Cremers AL, Heuvelings CC, Greve PF, Visser BJ, Bélard S, et al. Barriers and facilitators to the uptake of tuberculosis diagnostic and treatment services by hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review of qualitative literature. Lancet Infect Dis. 2017;17(5):e128-43.  https://doi.org/10.1016/S1473-3099(16)30531-X  PMID: 28291721 
  28. Zammarchi L, Casadei G, Strohmeyer M, Bartalesi F, Liendo C, Matteelli A, et al. . A scoping review of cost-effectiveness of screening and treatment for latent tubercolosis infection in migrants from high-incidence countries. BMC Health Serv Res. 2015;15(1):412.  https://doi.org/10.1186/s12913-015-1045-3  PMID: 26399233 
  29. Heuvelings CC, de Vries SG, Greve PF, Visser BJ, Bélard S, Janssen S, et al. Effectiveness of interventions for diagnosis and treatment of tuberculosis in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review. Lancet Infect Dis. 2017;17(5):e144-58.  https://doi.org/10.1016/S1473-3099(16)30532-1  PMID: 28291722 

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