Do 3-Year-Olds Need Preventive TB Medication After Positive Skin Test?

Q: Do 3-Year-Olds Need Preventive TB Medication After Positive Skin Test?

Hello： Numerous international studies have shown that the lifetime risk of developing active tuberculosis (TB) among contacts of infectious pulmonary tuberculosis cases is as high as 17% for children, compared to 5% for adults. <br>Data from our country also indicate that younger

Skin test of 10 cm for a 3-year-old child?

Hello, doctor.
I would like to ask you a question.
My grandfather, who lives with us, has been diagnosed with tuberculosis.
My 3-year-old son had a normal chest X-ray, but his skin test measured exactly 10 mm.
The pediatric infectious disease doctor recommended preventive medication for 9 months.
I have read online that children who have received the BCG vaccine may have altered skin test results, leading to false-positive results.
Is it really necessary for him to take the medication? Will the medication have any side effects on a 3-year-old child?

ivy, 30~39 year old female. Ask Date: 2017/12/17

Dr. Pei Rensheng reply Pediatrics

Hello: Numerous international studies have shown that the lifetime risk of developing active tuberculosis (TB) among contacts of infectious pulmonary tuberculosis cases is as high as 17% for children, compared to 5% for adults.
Data from our country also indicate that younger contacts have a higher probability of developing the disease after infection, particularly preschool-aged children, who are approximately 240 times more likely to develop the disease than their peers, while adults are 8 to 50 times more likely than their counterparts.
Detailed treatment guidelines are attached, and on page 13 it indicates that treatment should be administered; please note that the main side effect of isoniazid (INH) is hepatitis, so be vigilant for any signs of jaundice.
Wishing you health and happiness! Sincerely, Pediatric Department, Taoyuan Hospital.

Reply Date: 2017/12/17

More Info

When it comes to the management of tuberculosis (TB) in children, particularly in the context of a positive skin test (also known as the tuberculin skin test or TST), there are several important factors to consider. In your case, the 3-year-old child has been living with a grandparent who has confirmed pulmonary tuberculosis, and the child has a skin test result of 10 mm, which is considered positive. The child's chest X-ray is normal, which is a good sign, but the recommendation for preventive medication is based on the risk of developing active TB.

Understanding the Need for Preventive Medication
1. Risk of Progression: Children, especially those under the age of 5, are at a significantly higher risk of developing active TB if they have been exposed to someone with infectious TB. Studies indicate that the lifetime risk of developing TB after exposure can be as high as 17% for young children, compared to 5% for adults. Given that the child has been in close contact with a confirmed case, the recommendation for preventive treatment is prudent.

2. Positive Skin Test Interpretation: The positive skin test indicates that the child has been exposed to the TB bacteria at some point. However, it does not necessarily mean that the child has active TB disease, especially since the chest X-ray is normal. The BCG vaccine, which is often administered in many countries to prevent TB, can cause false-positive results in skin tests. However, the presence of a 10 mm induration in a child with known exposure to TB is still significant and warrants further action.

3. Preventive Treatment: The standard preventive treatment for latent TB infection in children is Isoniazid (INH), typically administered for 9 months. This treatment is effective in reducing the risk of developing active TB disease later on. The benefits of taking INH generally outweigh the risks, especially in a child with known exposure to TB.

Potential Side Effects of Isoniazid
While Isoniazid is generally well-tolerated, it can have side effects, the most notable being hepatotoxicity (liver damage). In children, the risk of developing drug-induced liver injury is lower than in adults, but it is still important to monitor for symptoms such as jaundice (yellowing of the skin or eyes), dark urine, or unexplained fatigue. Routine liver function tests may be recommended during the course of treatment to ensure the child's liver is functioning properly.

Conclusion
In summary, given the child's exposure to a confirmed TB case and the positive skin test result, preventive treatment with Isoniazid is advisable. The potential benefits of preventing active TB disease far outweigh the risks associated with the medication. It is essential to maintain close communication with the healthcare provider, monitor for any side effects, and ensure regular follow-ups to assess the child's health during the treatment period.
If there are any concerns about the child's reaction to the medication or if any symptoms arise, it is crucial to consult the healthcare provider promptly. Overall, the goal is to protect the child from developing active TB, which can have serious health implications.

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