Research Article
Volume 9 Issue 3 - 2020
Prevalence of Latent Mycobacterium tuberculosis among School Children in Lebanon
Merna El Khansa, Amal Naous* and Mariam Rajab
Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
*Corresponding Author: Amal Naous, Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon.
Received: January 08, 2020; Published: February 10, 2020


Aim: This study aimed to determine the prevalence of LTBI among Lebanese healthy school children and to compare the result with a previous study done in Lebanon in 2004 which showed a prevalence of 7.5%.

Methods: A self-administered questionnaire, including demographic characteristics, time of prior Bacillus Calmette-Guérin (BCG) vaccine, known household contact with tuberculosis as well as parents' characteristics and living conditions were administered. Purified protein derivative (PPD) testing was performed on selected school children aged between 3 and 19 years of age. Schools were selected from 4 Governorates of Lebanon (Beirut, Bekaa, South and North). We measured PPD reactivity. LTBI cases were defined by positive PPD test. Chest radiographs were obtained as part of the evaluation for children with positive PPD.

Results: Of the 5858 distributed questionnaires, 2805 school children entered into our final data analysis. 2688 (95.8%) had negative PPD test, and 117 (4.2%) had positive PPD test. None of the participants demonstrated TB-related abnormality on Chest X-ray. The highest prevalence was in Bekaa (4.9%) followed by Beirut (4.6%), South (4.3%), then North (1.9%) (P = 0.033). The prevalence of LTBI was higher among non-Lebanese population (P = 0.007). Of 33% of children who were BCG vaccinated, 4.3% had positive PPD test, and from the remaining 67% who were non-BCG vaccinated children, 4% had positive PPD test, with no statistically significant P-value (P = 0.443).

Conclusion: Our prevalence of LTBI among school children is 4.2% which indicates a decrease in the prevalence in our country over the last 10 years. This data support the recommendation to screen for tuberculosis even for vaccinated children to reach the WHO End TB Strategy by 2030.

Keywords: Latent Tuberculosis; PPD; BCG; Induration


  1. WHO. Global tuberculosis report (2016).
  2. Powell DA and Hunt WG. “Tuberculosis in children: an update”. Advances in Pediatrics. 53 (2006): 279-322.
  3. Lebanese Ministry of Public Health. “National Guidelines for Tuberculosis Prevention, Care and Elimination in Lebanon National TB Program– 2017”.
  4. S Swaminathan S and Rekha B. “Pediatric tuberculosis: global overview and challenges”. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 50.3 (2010): S184-194.
  5. Loeffler AM. “Pediatric tuberculosis”. Seminars in Respiratory Infections 18.4 (2003): 272-291.
  6. Sleiman R., et al. “Interpretation of the tuberculin skin test in bacille Calmette-Guerin vaccinated and nonvaccinated school children”. The Pediatric Infectious Disease Journal 26.2 (2007): 134-138.
  7. United Nations High Commissioner for Refugees: Syria regional refugee response (2014).
  8. Cookson ST., et al. "Impact of and response to increased tuberculosis prevalence among Syrian refugees compared with Jordanian tuberculosis prevalence: case study of a tuberculosis public health strategy". Conflict and health 9 (2015): 18.
  9. Red book 30th edition. Mycobacterium Tuberculosis (2015).
  10. Hu Y., et al. “Prevalence of latent tuberculosis infection and its risk factors in schoolchildren and adolescents in Shanghai, China”. European Journal Of Public Health 23.6 (2013): 1064-1069.
  11. Alavi SM and Sefidgaran GH. “Tuberculin survey among school-aged children in Ahvaz, Iran, 2006”. International Journal of Infectious Diseases: IJID: official publication of the International Society for Infectious Diseases 12.4 (2008): 406-409.
  12. Araj GF., et al. “Tuberculosis Burden in Lebanon: Evolution and Current Status”. Le Journal medical libanais The Lebanese Medical Journal 64.1 (2016): 1-7. 
  13. WHO. Global tuberculosis report (2015).
  14. Walls T and Shingadia D. “Global epidemiology of paediatric tuberculosis”. The Journal of Infection 48.1 (2004): 13-22.
  15. Seddon JA and Shingadia D. “Epidemiology and disease burden of tuberculosis in children: a global perspective”. Infection and Drug Resistance 7 (2014): 153-165.
  16. Diwan VK and Thorson A. “Sex, gender, and tuberculosis”. Lancet 353 (1999): 1000-1001.
  17. Wang L., et al. “A meta-analysis of the effect of Bacille Calmette Guerin vaccination on tuberculin skin test measurements”. Thorax 57.9 (2002): 804-809.
  18. Chee CB., et al. “Interpretation of the tuberculin skin test in Mycobacterium bovis BCG-vaccinated Singaporean schoolchildren”. American Journal of Respiratory and Critical Care Medicine 164.6 (2001): 958-961.
  19. Almeida LM., et al. “Use of purified protein derivative to assess the risk of infection in children in close contact with adults with tuberculosis in a population with high Calmette-Guerin bacillus coverage”. The Pediatric Infectious Disease Journal 20.11 (2001): 1061-1065. 
  20. Gounder CR., et al. “Tuberculin testing and risk of tuberculosis infection among New York City schoolchildren”. Pediatrics 111.4 (2003): e309-e315.
  21. Raharimanga V., et al. “Tuberculin reactivity in first-year schoolchildren in Madagascar”. Tropical Medicine and International Health 17.7 (2012): 871-876.
  22. Gulnar SB and Bulut BU. “Influence of BCG vaccination on tuberculin reactivity in healthy Turkish school children”. Acta Paediatrica 86.5 (1997): 549.
  23. Mudido PM., et al. “The effect of bacille Calmette-Guerin vaccination at birth on tuberculin skin test reactivity in Ugandan children”. The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 3.10 (1999): 891-895. 
  24. Lohiya GS., et al. “Interpretation of the tuberculin skin test”. Journal of the National Medical Association. 101.3 (2009): 282-283. 
  25. Kiwanuka JP. “Interpretation of tuberculin skin-test results in the diagnosis of tuberculosis in children”. African Health Sciences 5.2 (2005): 152-156.
Citation: Amal Naous., et al. “Prevalence of Latent Mycobacterium tuberculosis among School Children in Lebanon”. EC Paediatrics 9.3 (2020): 01-09.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

December Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 23, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.