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Alice L. Pong, MD; Bronwen J. Anders, MD; Kathleen S. Moser, MD; Monica Starkey, MPH; Almut Gassmann, MD; Richard E. Besser, MD

Arch Pediatr Adolesc Med. 1998;152:646-650.

Background  High immigration rates contribute to the high incidence of pediatric tuberculosis (TB) in San Diego, Calif. Adolescents frequently have poor access to health care and may not receive appropriate TB screening. School-based screening has been ineffective in detecting TB in other parts of the country.

Objective  To determine the prevalence of TB infection and disease in a high-risk population of high school students through school-based screening.

Design and Participants  Cross-sectional study of TB prevalence and an analysis of risk factors for TB infection in students attending 2 San Diego high schools with high percentages of non–US-born students.

Main Outcome Measures  Positive induration (10 mm) with Mantoux tuberculin skin test. A chest radiograph or clinical findings consistent with active TB.

Results  A total of 744 (36%) students at high school 1 and 860 (57%) students at high school 2 participated. Ninety-five (12.8%) and 207 (24.1%) students, respectively, had positive tuberculin skin test results. One student had a chest radiograph that showed active TB. Smear for acid-fast bacteria and culture for Mycobacterium tuberculosis had negative results. Vietnamese, Filipino, and Latino ethnic groups were significantly more likely to have positive tuberculin skin test results than the white population (P<.05). Non–US-born students were significantly more likely to have positive tuberculin skin test results than US-born students in all ethnic groups except the Latino group.

Conclusion  Although treatment of TB coupled with aggressive public health investigation is the most cost-beneficial way of preventing TB, targeted school-based screening may be an effective way of detecting TB infection in high-risk populations with poor access to health care.

From the Department of Pediatrics, University of California San Diego Medical Center (Drs Pong, Anders, Gassmann, and Besser and Ms Starkey), and the County of San Diego Department of Health Services (Dr Moser).

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