States and school districts differ on whether all children should be tested for tuberculosis infection before they enter kindergarten, and an article in the July issue of the journal Pediatrics asks whether such universal testing is cost-effective. Using California as an example, researchers noted that public officials have made decisions about whether to require testing "based on the available evidence and local preferences." A universal TST (tuberculosis skin test) is mandated as part of the screening component of the Early and Periodic Screening Diagnosis and Treatment (EPSDT) program, and the researchers note that routine skin testing of all children is still practiced in many parts of the United States. That's despite a recommendation by the Pediatric Tuberculosis Collaborative Group, which recommended in 2004 that universal TST should be replaced by "risk factor screening" based on responses to questions such as country of birth, travel history, exposure to TB, and close contact with someone with positive TST results. When they looked at the cost-effectiveness of universal versus targeted screening (in terms of the costs of full-blown tuberculosis to the health system), the researchers concluded that they "strongly support" the recommendations of the Pediatric Tuberculosis Group for discontinuing universal TST of children. The article, "Cost-effectiveness of Alternative Strategies for Tuberculosis Screening Before Kindergarten Entry" appears in the July 2007 issue of the journal Pediatrics.