Introduction

The UK has one of the highest rates of tuberculosis (TB) in Western Europe.1 If current trends continue, with over 7500 cases per year,2 England will overtake the whole of the USA in the annual number of TB notifications within the next 2 years.3 TB disease in UK children is relatively rare with <5% cases affecting patients under the age of 15 years.2 Outside large conurbations, most paediatricians will see very few children with TB. However, the risk of progression from latent TB to TB disease and of TB meningitis or miliary TB is much higher in children, especially those under the age of 2 years.4 It is, therefore, important that paediatricians recognise children at risk of TB disease and the symptoms and signs with which they present.

This article summarises the recently updated National Institute for Health and Care Excellence (NICE) guideline ‘Tuberculosis’ (NG33)5 ,6 published in 2016 (box 1). Several areas of this guideline are controversial and we will highlight these.

Key recommendations in the updated guideline:

• A Mantoux test induration of ≥5 mm is defined as positive irrespective of prior BCG.

• Screen all contacts of pulmonary or laryngeal TB cases and new entrants from high incidence areas for latent TB infection (LTBI) (box 2).

• Interferon-γ release assays (IGRAs) alone should only be used in children and young people if Mantoux not available or is impractical (eg, situations where large numbers need to be tested).

• The upper age limit for testing for latent TB is increased from 35 to 65 years.