Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplanta
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REVIEW
Preventing tuberculosis in paediatric kidney transplant recipients: is there a role for BCG immunisation pre-transplantation in low tuberculosis incidence countries? Alasdair Bamford 1,2 & Garth Dixon 3,2 & Nigel Klein 1,2 Steven B. Welch 7 & Marc Tebruegge 2,6,8
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Stephen D. Marks 4,2
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Nicole Ritz 5,6
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Received: 27 May 2020 / Revised: 27 September 2020 / Accepted: 26 October 2020 # The Author(s) 2020, corrected publication 2020
Abstract The risk of tuberculosis (TB) disease is increased in children with chronic kidney disease (CKD), even higher in stage 5 CKD/ kidney failure and especially high after kidney transplantation due to immunosuppression. TB disease may follow recent primary infection, or result from reactivation of latent infection. Reactivation is more common in adults, while progression following primary infection makes up a greater proportion of disease in children. Recommendations for preventing TB disease in some low TB incidence countries have previously included offering Bacillus Calmette-Guérin (BCG) vaccine to all children listed for kidney transplant if they had not received this as part of previous national immunisation programmes. Based on the available evidence, we recommend modifying this practice, focusing instead on awareness of risk factors for TB exposure, infection and disease and the use of appropriate testing strategies to identify and treat TB infection and disease. Keywords Tuberculosis . BCG . Chronic kidney disease . Transplant . Children
Summary
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Diagnosing tuberculosis infection
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Assessment for tuberculosis (TB) infection and disease has three components:
Assessment of risk factors for TB exposure, or confirmed history of TB exposure Diagnostic immunological tests for TB infection (tuberculin skin test (TST) and interferon-gamma release assays (IGRAs)), which are less sensitive in the presence of
Steven B. Welch and Marc Tebruegge contributed equally to this work. Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s00467-02004844-5. * Alasdair Bamford [email protected] 1
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University of Basel Children’s Hospital, Paediatric Infectious Disease and Vaccinology Department, Migrant Health Service, Basel, Switzerland
Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Department of Paediatrics, Royal Children’s Hospital Melbourne, University of Melbourne, Melbourne, Australia
University College London Great Ormond Street Institute of Child Health, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
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Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
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Department of Paediatric Infectious Diseases & Immunology, Evelina London Children’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
Department of Paediatirc Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK Department of Paediatric N
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