{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T07:23:07Z","timestamp":1787296987520,"version":"build-2736575974"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":31,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Hangzhou Health Science and Technology Project","award":["B20240299"],"award-info":[{"award-number":["B20240299"]}]},{"name":"Zhejiang Provincial Science and Technology Program for Disease Prevention and Control","award":["2025JK181"],"award-info":[{"award-number":["2025JK181"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Trop Med Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Larger tuberculin skin test (TST) reactions are associated with higher tuberculosis (TB) risk, but the operational value of the\u2009\u2265\u200915\u00a0mm threshold among adolescents who already have a TST induration\u2009\u2265\u200910\u00a0mm during routine school screening is less well characterised in high-BCG coverage settings. We assessed whether TST induration\u2009\u2265\u200915\u00a0mm provided incremental risk stratification information for secondary school students and interpreted this threshold across routine screening, outbreak contact and previously cured TB contexts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a historical cohort study using school-based TB screening and TB management data from Yuhang District, Hangzhou, China. The primary cohort included 6077 students aged 12\u201318\u00a0years who were screened between September 2023 and November 2025 with a baseline TST induration\u2009\u2265\u200910\u00a0mm and no active TB at screening. Students were classified as having a TST\u2009\u2265\u200915\u00a0mm or a TST 10\u201314\u00a0mm. The incidence of active pulmonary TB was ascertained by deterministic linkage with TB management systems. Students in the 2020\u20132022 TST\u2009\u2265\u200915\u00a0mm routine-screening descriptive cohort, school-outbreak contacts and previously cured TB patients were analysed descriptively and were not included in the primary inferential comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the primary cohort, four incident active pulmonary TB cases occurred among students with TSTs\u2009\u2265\u200915\u00a0mm (0.25%; 169.03 per 100 000 person-years), whereas none occurred among students with TSTs 10\u201314\u00a0mm. The adjusted incidence density ratio was 22.74 (95% CI 2.42\u20133015.62; P\u2009=\u20090.004), with wide uncertainty due to sparse events. The 2020\u20132022 TST\u2009\u2265\u200915\u00a0mm routine-screening descriptive cohort had a similarly low absolute incidence (128.64 per 100 000 person-years). In the outbreak contact cohort, the incidence among TST\u2009\u2265\u200915\u00a0mm contacts was 438.68 per 100 000 person-years; this estimate was interpreted descriptively because baseline definitions and preventive-treatment coverage differed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A TST induration of\u2009\u2265\u200915\u00a0mm was associated with a higher incidence of active pulmonary TB in students than a TST of 10\u201314\u00a0mm, but the absolute risk after routine screening remained low. The threshold should be interpreted as a context-dependent risk marker that can support, but should not replace, the assessment of exposure history, previous TB and time since screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s41182-026-01034-1","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T02:07:59Z","timestamp":1784599679000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Context-dependent risk stratification using a tuberculin skin test induration threshold of\u2009\u2265\u200915 mm in school tuberculosis screening in Hangzhou, China: a historical cohort study"],"prefix":"10.1186","volume":"54","author":[{"given":"Xiangjie","family":"Meng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Shou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"1034_CR1","volume-title":"Global tuberculosis report 2025","author":"World Health Organization","year":"2025","unstructured":"World Health Organization. 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The requirement for informed consent was waived because this record-based historical analysis used an anonymised analytic dataset after record linkage. All procedures were performed in accordance with the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. The manuscript does not contain data from any individual person in identifiable form.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"166"}}