R J Bowerman1. 1. Department of Community Health, Mennonite Christian Hospital, Hualien, Taiwan. ron_bowerman@sil.org
Abstract
SETTING: Various populations at high risk for tuberculosis (TB) infection and with high bacille Calmette-Guérin (BCG) vaccination coverage in eastern Taiwan. OBJECTIVE: To investigate the usefulness of the tuberculin skin test (TST) to diagnose TB in BCG-vaccinated populations. DESIGN: Cross-sectional survey. RESULTS: TST reaction size was recorded for 444 individuals ranging in age from 8 months to 99 years, of whom 94.3% had scars to suggest previous BCG vaccination. The TST-positive (> or =10 mm) rate was increased in all comparisons of higher to lower TB risk, including household contacts (relative risk [RR] 3.52, P < 0.0001) and intermediate risk residents (RR 2.30, P = 0.030) compared to a lower risk control group. Advancing age was generally associated with increases in the TST-positive rate. Gender or the number of BCG vaccinations had no relation to the TST-positive rate. CONCLUSIONS: The results of this survey suggest that in eastern Taiwan a positive TST represents either active or latent TB infection rather than past BCG vaccination. Therefore, high BCG vaccination coverage in this region does not appear to limit the usefulness of the TST as a tool for diagnosing TB.
SETTING: Various populations at high risk for tuberculosis (TB) infection and with high bacille Calmette-Guérin (BCG) vaccination coverage in eastern Taiwan. OBJECTIVE: To investigate the usefulness of the tuberculin skin test (TST) to diagnose TB in BCG-vaccinated populations. DESIGN: Cross-sectional survey. RESULTS: TST reaction size was recorded for 444 individuals ranging in age from 8 months to 99 years, of whom 94.3% had scars to suggest previous BCG vaccination. The TST-positive (> or =10 mm) rate was increased in all comparisons of higher to lower TB risk, including household contacts (relative risk [RR] 3.52, P < 0.0001) and intermediate risk residents (RR 2.30, P = 0.030) compared to a lower risk control group. Advancing age was generally associated with increases in the TST-positive rate. Gender or the number of BCG vaccinations had no relation to the TST-positive rate. CONCLUSIONS: The results of this survey suggest that in eastern Taiwan a positive TST represents either active or latent TB infection rather than past BCG vaccination. Therefore, high BCG vaccination coverage in this region does not appear to limit the usefulness of the TST as a tool for diagnosing TB.