To the Editor.
—Those of us involved in TB control programs at the local level appreciate the implications of the cost-benefit analysis by Dr Mohle-Boetani and colleagues.1 Conducting more directed screening of childhood-aged subpopulations rather than routine mass screening of children at presumed high risk has become a much needed recommendation and has substantial cost savings to TB programs. We recently conducted a smaller analysis of the effectiveness of and cost to our local TB program in fulfilling the early periodic screening, diagnosis, and treatment (EPSDT) mandate to routinely screen children enrolled in Medicaid in the state of Alabama.During 1993 and 1994, Jefferson County Department of Health pediatric clinics performed 18441 EPSDT tine tests to screen for TB in children between the ages of 1 and 19 years. All patients with positive tine tests were retested by our TB staff using intermediate-strength purified-protein derivative (IPPD) tests. Only one
Fleenor ME, Curtis G. Screening for Tuberculosis. JAMA. 1995;274(24):1913. doi:10.1001/jama.1995.03530240022030