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

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