TB Manual

Resources should be devoted to the task of testing and treating children at high risk of TB infection or of progression of TB infection to TB disease, with the objective of providing health benefits to the individual child.⁹⁸ These children include: (1) contacts of a known/suspected case of TB disease; (2) children with suspected TB disease; (3) children with known risk factors for progression of TB infection to disease (see Chapter 4: Diagnosis of Tuberculosis Infection); (4) children traveling or residing for 3 months or longer in an area with a high incidence of TB, especially if the visit is anticipated to involve contact with the local population (see Chapter 13: Tuberculosis Surveillance and Tuberculosis Infection Testing and Treatment in Migrants); and (5) children who arrived in Canada from countries with a high TB incidence. The risk-benefit tradeoff of drug toxicity secondary to preventive treatment versus the development of TB disease more often favors preventive treatment in children compared to adults. In the United States, risk assessment questionnaires have been developed to identify children with risk factors for TB and TB infection who should undergo a TST.¹⁰³,¹⁰⁴ Implementation of a similar strategy in Canada may help to better identify infected children here. Confining evaluation to children and adolescents from countries with a TB incidence >30/100,000 would likely capture more than 75% of those at risk for developing TB disease.^105,106

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