Algorithm for TB Testing in Children TB Risk Questionnaire positive? Screening Complete No Yes TST Preferred* Age < 5 years? Yes No Likely to return for TST reading? TST or IGRA Acceptable BCG Vaccinated? No Yes Yes No Initial TST Done? No IGRA Preferred Yes Positive TST Result? Negative Yes Concern for TB disease?* Positive, testing complete Negative Indeterminate No Repeat IGRA Concern for TB disease?* Negative, testing complete Indeterminate No Yes Negative, testing complete Consider TST if not done *Either positive TST or IGRA considered significant (indicative of TB infection or disease) if there is clinical suspicion of disease or high risk for progression or poor outcome in patients with latent TB infection Geltemeyer A, Smith KC. 16th Annual Conference of the IUATLD-North American Region, Feb 2012.