Chest Radiograph in Migrant Children

To the Editors: Migrant health screening may vary according to the country and practitioners. With an incidence of 0.02% to 2% for tuberculosis disease (TBD) and 11% to 19% for latent tuberculosis (LTB) in migrant children, tuberculosis screening is considered a priority in the assessment of people coming from endemic countries,1 especially as the risk for TBD is higher in the years following the journey.2 If most guidelines recommend a systematic screening for LTB in migrant children using ɤ-interferon release assay (IGRA) and/or tuberculin skin testing (TST), the role of chest radiograph (CXR) is less clear. European guidelines recommend systematic CXR in migrant children,3 while North American guidelines recommend performing CXR only in children with a positive TST/IGRA.3 In France, no specific recommendation exists about CXR in this context.4 Given the lack of standardized practices for CXR, we aim to share our results concerning its diagnosis value on tuberculosis and other diseases in asymptomatic newcomers’ children. We retrospectively included all the asymptomatic children who attended our consultation between 2020 and 2023, excluding those with positive IGRA and/or TST. All underwent a CXR (frontal and lateral views). Our primary end point was the number of new diagnoses of previously undetected diseases made by CXR. This study was approved by the local ethics committee (IRB 00006477). Among the 230 children screened, 159 (70%) were included (Fig. 1), most from the African continent (n=137,86%). Median age was 7.2 (interquartile range, 4.3–13.1) years, with a predominance of males (n= 93, 58%). Only 3 patients were aged <2 years. The initial assessment was performed on an average of 5.3 (interquartile range, 3.3–7.8) months after the arrival. Of 159 CXR analyzed, 5 (3%) showed radiographic anomalies. Four patients had an already known disease (rickets: 2 patients; congenital heart disease: 2 patients). The last patient underwent a CT scan, which was normal.FIGURE 1.: Flowchart. IQR indicates interquartile range.Our report shows that performing a systematic CXR in asymptomatic, IGRA-negative newly arrived children does not prove added value compared to the usual health screening, both for tuberculosis and non-TBD. Noteworthy, we used IGRA for tuberculosis screening. The sensitivity of IGRA and TST is considered similar for TBD screening, but IGRA has a better specificity in Bacillus Calmette-Guerin-vaccinated children.4 Previous studies with long-term follow-up of TST-positive/IGRA-negative children (mainly migrant newcomers) did not observe TBD for untreated children.5 Thus, the use of IGRA instead of TST for newcomer children reduces false positives, thereby minimizing unnecessary CXR and LTB treatment. Our results are limited by the small size and the heterogeneity of the included population in terms of age and social situation. Moreover, we included very few children <2 years old, who might be less symptomatic and potentially require a specific study. However, our study provides clinical data showing that performing a systematic CXR without clinical or biological indications does not enhance the quality of the arrival screening of newly arrived children. Reduced CXR indications may simplify the initial screening and limit children’s exposure to radiation.