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Table 2 Recommendations for the use of Tuberculin Skill Test (TST) and Interferon-gamma Release Assay (IGRA) in children

From: Tuberculosis in childhood: a systematic review of national and international guidelines

  TST alone IGRA alone both TST and IGRA
WHO [6] • Any child, irrespective of HIV status, in low and middle-income countries   
NICE [22] • Children younger than 5 years • BCG vaccinated children (> 5 years of age)
• Children > 5 years of age, in an outbreak situation
• Children > 5 years of age whose TST is positive
American [12, 16] • Children younger than 5 years
• Before initiation of immunosuppressive therapy
• BCG vaccinated children (> 5 years of age)
• Children > 5 years of age who are unlikely to return for TST reading
• Before starting immunosuppressive therapy
• The initial and repeat IGRA are indeterminate
• The initial test (TST or IGRA) is negative and:
- clinical suspicion for TB disease is moderate to high
- risk of progression and poor outcome is high
• The initial TST is positive and:
- Children > 5 years of age who have received BCG vaccine
- Non-tuberculous mycobacterial disease is suspected
- Additional evidence are needed to increase compliance
European [19] • Children younger than 5 years
• Children > 5 years who are:
- not HIV-infected
- not BCG vaccinated
• BCG vaccinated children (> 5 years of age) • HIV-infected children
• Before starting immunosuppressive therapy (anti-TNFalfa inhibitor therapy)
Spanish [23] • Any child   • The initial TST is negative and:
- Immunocompromised children
- High risk of infection, of progression to disease and of a poor outcome
• The initial TST is positive and:
- BCG vaccinated children
- Risk factors are negative
Canadian [31] • Whenever it is planned to repeat the test later to assess risk of new infection (i.e. conversions) • People who have received BCG vaccination
• People from groups that historically have poor rates of return for TST reading.
• High risk of infection, of progression to disease and of a poor outcome
• The initial and repeat IGRA are indeterminate
  1. Note. WHO: World Health Organization; BCG: Bacille Calmette-Guèrin