OpiniãoThe evidence reviewed about the performance of symptom screening among children and adolescents younger than 15 years who are close contacts of someone with TB included 4 studies with a total of 2 695 participants (see Web Annex B, Table 17, and Web Annex C, Table 10). In this population, a symptom screen involving any one of cough, fever or poor weight gain (where the presence of any symptom constitutes a positive screen), when compared against a composite reference standard, had a pooled sensitivity of 0.89 (95% CI: 0.52–0.98) and a pooled specificity of 0.69 (95% CI: 0.51–0.83).
The evidence reviewed about the performance of chest radiography among close contacts younger than 15 years of TB patients included 4 studies with a total of 2 550 participants (see Web Annex B, Table 18, and Web Annex C, Table 8). Compared with a composite reference standard, chest radiography using abnormalities suggestive of TB as a positive screen had a pooled sensitivity of 0.84 (95% CI: 0.70–0.92) and a pooled specificity of 0.91 (95% CI: 0.90–0.92).
Despite the absence of high-certainty evidence for test accuracy, the GDG felt that a strong recommendation was warranted for both of the tools being considered for close contacts younger than 15 years, given the high risk of disease and of mortality if the diagnosis is missed and TB is left untreated