More often than active tuberculosis disease children have latent tuberculosis infection (ltbi), which can occur after contact with a patient suffering from smear-positive pulmonary tuberculosis, usually an adult household member. In young children the infection is almost always recently acquired. Compared to adults, infected children, especially children with an immune disorder, have an increased risk of progression to active tuberculosis disease, and will more frequently develop severe manifestations of tuberculosis, such as tuberculous meningitis or miliary tuberculosis. Treatment of ltbi considerably reduces the risk of progression to active disease. Most infected children are identified during contact investigations or immigration screening and treated by the Department of Tuberculosis Control of the Municipal Health Service. The tuberculin skin test is not always a reliable method to diagnose ltbi, particularly in children with a previous bcg vaccination or in children with a reduced immune response. Recently developed interferon-? tests may contribute to improved diagnosis of ltbi in the future. On account of the publication of new guidelines for diagnosis and treatment of ltbi in children in the United States as well as in the Netherlands, the policies and developments in the Netherlands are discussed.
