The Prevention of Tuberculosis in Children of Preschool Age in the United States

The child-Centered Program to Prevent Tuberculosis in the United States, of which the preschool program is a part, should provide a practical way to: (1) reduce the danger of first infection among young people; (2) find those tuberculin reactors in need of chemoprophylaxis to prevent the development of active disease, and (3) encourage followup chest x-ray examinations of tuberculin reactors, making possible the early discovery and specific treatment of new, active, asymptomatic, minimal cases of tuberculosis.

All children between the ages of six months and six years should have at least one properly performed and recorded test with 5 TU tuberculin, and those with a reaction of 10 mm induration or more should be registered by official health agencies for epidemiologic studies. This is a minimal but attainable goal in the United States at this time.

If possible, the first tuberculin test in childhood should be performed at six to 12 months of age. Thereafter, the recheck of tuberculin negative children under age six should be encouraged as a routine part of the immunization program and annual health examinations to gain wider application of the test. The tuberculin testing of this group of 25 million children in the United States is a difficult task, but each community must evaluate its own needs and resources and implement the most effective program possible. The alternative— waiting for the mass tuberculin survey of 4 million children entering the first grade of public schools—does not provide the same opportunity of finding the tuberculin converters early in life when protection is most needed and when the source of infection is most apt to be found. When preschool testing is not done, however, children should be taken care of in this manner.

The control of tuberculosis in the United States must not be dissociated from the general program to prevent other communicable diseases, but the special problems connected with the prevention of childhood infections and the lifelong danger of endogenous reinfection among those infected with tubercle bacilli must become better known.