Changes in tuberculin sensitivity among first-grade students of elementary schools in Evros, Greece due to immigration

Mantadakis, E.; Arvanitidou, V.; Tsalkidis, A.; Ramatani, A.; Triantafillidou, E.; Trypsianis, G.; Dipla, V.; Thomaidis, S.; Bouros, D.; Chatzimichael, A.

doi:10.1016/j.puhe.2009.07.003

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Volume 123, Issue 9 , Pages 618-622, September 2009

Changes in tuberculin sensitivity among first-grade students of elementary schools in Evros, Greece due to immigration

E. Mantadakis
- Department of Paediatrics, Democritus University of Thrace, Thrace, Greece
- Department of Paediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece
V. Arvanitidou
- Department of Paediatrics, Democritus University of Thrace, Thrace, Greece
- Department of Paediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece
A. Tsalkidis
- Department of Paediatrics, Democritus University of Thrace, Thrace, Greece
- Department of Paediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece
A. Ramatani
- Department of Paediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece
E. Triantafillidou
- Department of Paediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece
G. Trypsianis
- Department of Biostatistics, Democritus University of Thrace, Thrace, Greece
V. Dipla
- Department of Paediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece
S. Thomaidis
- Department of Paediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece
D. Bouros
- Department of Pneumonology, Democritus University of Thrace, Thrace, Greece
A. Chatzimichael
- Department of Paediatrics, Democritus University of Thrace, Thrace, Greece
- Department of Paediatrics, University General Hospital of Alexandroupolis, Alexandroupolis, Thrace, Greece
- Corresponding author. Democritus University of Thrace and University Hospital of Alexandroupolis, 6th Kilometer Alexandroupolis-Makris, 68 100 Alexandroupolis, Thrace, Greece. Tel.: +30 25510 74429; fax: +30 25510 74428.

Received 8 December 2008; received in revised form 16 April 2009; accepted 9 July 2009. published online 22 September 2009.

Summary

Objective

To investigate the tuberculin sensitivity trends among first-grade students of elementary schools tested according to the Greek national school-based screening and vaccination programme.

Study design

Retrospective analysis of tuberculin skin test (TST) results from 1988 to 2004 in unvaccinated first-grade students in Evros, Greece.

Methods

All 6–7-year-old children who were unvaccinated for tuberculosis were tested by a highly experienced team. This study tested whether gender (male vs female), national origin (native vs foreign-born children) and place of residence (urban vs semi-urban vs rural) correlated with tuberculin reaction positivity.

Results

In total, 8588 children (47.1% girls) were tested. Tuberculin reaction positivity was independent of gender. The difference in TST positivity between native and foreign-born children between 1993 and 2004 was highly significant, with substantially more foreign-born children having a positive Mantoux test (P<0.0001). The percentage of children with a positive TST peaked at 13% in 1995 due to initial admission of foreign-born children, originating from countries of the former Soviet Union, into the Greek educational system. In addition, a positive Mantoux test was more common among children living in rural (8.1%) and semi-urban (6.4%) areas compared with children living in urban areas (3.5%, P<0.0001).

Conclusion

The increase in TST positivity noted was due to admission of foreign-born children into the Greek educational system. School-based tuberculosis screening programmes should continue in Greece because the prevalence of tuberculosis appears to show substantial variation between years.

Keywords: Tuberculosis, Epidemiology, Mantoux skin test, Immigration, Greece