[Scope of Initial Examinations of Unaccompanied Minor Foreigners: A Nationwide Population Survey]. / Umfang der Erstuntersuchungen bei unbegleiteten minderjährigen Ausländern: eine bundesweite Bestandsaufnahme.

BACKGROUND: When unaccompanied minors (UMA) are taken into provisional care by the youth welfare offices, it is legally obligatory to carry out an initial medical examination and obtain a statement as to whether the state of health of minors excludes the implementation of the distribution procedure according to the Königsberg Key and, in the case of 15-year-olds and non-pregnant persons, an X-ray thorax scan to exclude infectious tuberculosis of the lungs. The supreme state health authorities of the German federal states determine the further scope of the investigations. The aim of this nationwide survey is a comparison of the different concepts of the individual states with regard to the scope of the initial UMA investigations. METHODS: Between September 2016 and May 2018, a survey on the scope of the UMA initial investigations was conducted by e-mail with official contact persons. At the same time, a web-based search of the websites of the supreme health authorities of the federal states for official statements was carried out. RESULTS: In the areas of TB screening of under 15-year-olds and pregnant women as well as screenings for other diseases, the picture across Germany was sometimes very mixed. There was agreement above all in the recommendations for vaccination. CONCLUSION: Efforts to harmonise the scope of the investigation at the federal level should be pursued further.

Risk of tuberculosis transmission by children in Hamburg, Germany.

BACKGROUND: Data from a prospective molecular-epidemiologic study (1997-2021) in Hamburg, Germany, were evaluated to assess the transmission risk of Mycobacterium tuberculosis complex (Mtbc) by children <15 years in a low-incidence setting. METHODS: Isolates of Mtbc were genotyped whole genome sequencing, applying a core genome multilocus sequence typing scheme. Close contacts of culture-confirmed children were examined for latent Mtbc infections (LTBI) with particular focus on IGRA testing. RESULTS: Out of 3154 culture-confirmed tuberculosis (TB) cases, 79 (2.5%) were children <15 years. Of those, 52 (58%) had pulmonary TB. Genotyping revealed that 35 of the 52 children (67%) were epidemiologically confirmed secondary cluster members; all of their source cases were adults. Six immigrant children presented without a presumed source case; their TB diagnoses came on average 48 weeks (interquartile range [IQR] 71) after their arrival in Germany. Three German-born children were determined to have been infected by adult relatives while visiting their parents' home country. Of the 317 children's close contacts tested with QuantiFERON-TB Gold-In Tube for LTBI, only 21 (6.6%) were positive. Absent a history of prior exposure or immigration from a high-incidence country, none of the contacts of younger (<10 years) TB-afflicted children was latently infected, whereas 2 older children infected 12 of their contacts, children and adults. During a mean observational period of 551 weeks (IQR 735) on average, no secondary TB cases appeared. CONCLUSIONS: Children with pulmonary TB disease, especially those aged below 10 years, rarely transmit Mtbc to their close contacts in a low-incidence setting.