Suggested Uses of TST and IGRA in Children
| TST preferred |
| • Children younger than 5 ya |
| IGRA preferred, TST acceptable |
| • Children 5 y or older who have received BCG vaccine |
| • Children 5 y or older who are unlikely to return for the TST reading |
| Both the TST and an IGRA should be considered when: |
| • The initial and repeat IGRA results are indeterminate/invalid |
| • The initial test (TST or IGRA) result is negative and: |
| • There is clinical suspicion of TB diseaseb |
| • The child has a TB risk factor and is at high risk of progression and poor outcome (especially therapy with an immunomodulating biologic agent, such as a TNF-α antagonist)b |
| • The initial TST is positive and: |
| • The patient is 5 years or older and has a history of BCG vaccination |
| • Additional evidence is needed to increase adherence with therapy |
| TST preferred |
| • Children younger than 5 ya |
| IGRA preferred, TST acceptable |
| • Children 5 y or older who have received BCG vaccine |
| • Children 5 y or older who are unlikely to return for the TST reading |
| Both the TST and an IGRA should be considered when: |
| • The initial and repeat IGRA results are indeterminate/invalid |
| • The initial test (TST or IGRA) result is negative and: |
| • There is clinical suspicion of TB diseaseb |
| • The child has a TB risk factor and is at high risk of progression and poor outcome (especially therapy with an immunomodulating biologic agent, such as a TNF-α antagonist)b |
| • The initial TST is positive and: |
| • The patient is 5 years or older and has a history of BCG vaccination |
| • Additional evidence is needed to increase adherence with therapy |
TNF-α, tumor necrosis factor α.
Some experts will use an IGRA in children 2 to 4 years of age, especially if they have received a BCG vaccine but have no other significant risk factors. Most experts do not use an IGRA for children younger than 2 years because of lack of data for this age group and the high risk of progression to disease.
A positive result of either test is considered significant in these groups.