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We assessed the performance of parallel LTBI screening with tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube assays (QFT-GIT) before anti-TNF-\u03b1 treatment in children with immune-mediated inflammatory disorders in a low TB-burden setting. We conducted a multicenter cohort study involving 17 pediatric tertiary centers in Spain. LTBI was defined as the presence of a positive TST and\/or QFT-GIT result without clinical or radiological signs of TB disease. A total of 270 patients (median age:11.0\u00a0years) were included, mainly with rheumatological (55.9%) or inflammatory bowel disease (34.8%). Twelve patients (4.4%) were diagnosed with TB infection at screening (LTBI, <jats:italic>n<\/jats:italic>\u2009=\u200911; TB disease, <jats:italic>n<\/jats:italic>\u2009=\u20091). Concordance between TST and QFT-GIT results was moderate (TST+\/QFT-GIT+, <jats:italic>n<\/jats:italic>\u2009=\u20094; TST\u2212\/QFT-GIT+, <jats:italic>n<\/jats:italic>\u2009=\u20093; TST+\/QFT-GIT-, <jats:italic>n<\/jats:italic>\u2009=\u20095; kappa coefficient: 0.48, 95% CI: 0.36\u20130.60). Indeterminate QFT-GIT results occurred in 10 patients (3.7%) and were associated with young age and elevated C-reactive protein concentrations. Eleven of 12 patients with TB infection uneventfully completed standard LTBI or TB treatment. During a median follow-up period of 6.4\u00a0years, only 2 patients developed TB disease (incidence density: 130 (95% CI: 20\u2013440) per 100,000 person-years), both probable de novo infections.<\/jats:p><jats:p><jats:italic>Conclusion<\/jats:italic>: A substantial number of patients were diagnosed with LTBI during screening. The dual strategy identified more cases than either of the tests alone, and test agreement was only moderate. Our data show that in children in a low TB prevalence setting, a dual screening strategy with TST and IGRA before anti-TNF-\u03b1 treatment is effective.\n<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 The optimal screening strategy for latent tuberculosis in children with immune-mediated inflammatory disorders remains uncertain.<\/jats:italic><jats:italic>\u2022 Children receiving anti-TNF-\u03b1 drugs are at increased risk of developing severe tuberculosis disease.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 A dual screening strategy, using TST and an IGRA assay, identified more children with latent tuberculosis than either of the tests alone.<\/jats:italic><jats:italic>\u2022 Identification and treatment of latent tuberculosis before initiation of anti-TNF-\u03b1 therapy averted incident tuberculosis cases.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-022-04640-3","type":"journal-article","created":{"date-parts":[[2022,11,5]],"date-time":"2022-11-05T18:02:51Z","timestamp":1667671371000},"page":"307-317","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-\u03b1 inhibitor initiation in children in Spain"],"prefix":"10.1007","volume":"182","author":[{"given":"Joan","family":"Calzada-Hern\u00e1ndez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Anton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Mart\u00edn de 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The rest of the authors have no other conflicts of interest to disclose.\u00a0<b><i>Collaborators<\/i><\/b>  See Supplementary Appendix  for the complete list of investigators.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}