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Tuberculin reactivity in adult BCG-vaccinated subjects: a cross-sectional study
M Bugiani1, A Borraccino, E Migliore
1Pneumology Unit, Consorzio Provinciale Antitubercolare, Azienda Sanitaria Locale 4, Piedmont, Turin, Italy. mbugiani@qubisoft.it
Introduction:
Interpretation of the tuberculin skin test (TST) may be complicated by prior bacille Calmette-Guérin (BCG) vaccination. The skin reaction to the vaccination interferes with the management of individuals who may be infected with Mycobacterium tuberculosis.
Objective:
To discriminate between TST reactions due to infection and those due to vaccination in subjects with unknown BCG status.
Methods:
Among 60200 subjects tested with 5TU PPD for screening purposes, 4987 contacts of infectious TB cases (Group A), 4962 BCG-vaccinated subjects (Group B) and 5000 subjects from the general population (Group C) were sampled. The frequencies of TST cut-off diameters were calculated for the three groups using a logistic regression model. The frequency of positive subjects in each group and the sensitivity, specificity and predictive values were also computed by means of these cut-offs.
Results:
The risk of being a contact versus BCG-vaccinated increases 2.43-fold with every mm of TST diameter. The 11 mm cut-off point seems to be the best discriminating value.
Conclusions:
Using the traditional 10 mm cut-off, we can consider all vaccinated subjects with a positive TST to be infected. The TST remains a valuable tool for the evaluation of household contacts and suspected cases of tuberculosis in BCG-vaccinated subjects and in populations with high vaccination coverage.