Bacillus Calmette-Guérin immunization in infants born to HIV-1-seropositive mothers

During the prospective follow-up of 64 babies at risk for perinatal HIV-1 infection because their mothers were seropositive, and of 130 control babies whose mothers were seronegative, we studied the occurrence of complications of bacillus Calmette-Guérin (BCG) immunization and its ability to induce cutaneous reactivity to tuberculin. Babies born both to HIV-1-positive and HIV-1-negative mothers received BCG immunization during their first month of life according to the Expanded Programme on Immunization (EPI) recommendations. Local and regional complications of BCG vaccine were looked for at 3, 6 and 9 months after inoculation. A tuberculin skin test was performed at 6 or 9 months of age. Most babies born to HIV-1-positive mothers were later classified as infected or uninfected according to their clinical condition and/or serological status at 18 months of age. The mean duration of the follow-up was 36 months (range 30-40 months). No chronic or deep ulcerations at the site of injection or disseminated forms of BCG infection were observed. The frequency of BCG-related lymphadenitis in the group of HIV-1-infected children (24%) did not differ significantly from the group of uninfected children (19%; Fisher test: P = 0.73). In contrast, the tuberculin skin test responses were positive less often in the group of HIV-1-infected children (33%) than in the uninfected group (83%; Fisher test: P = 0.007). Because BCG vaccine appears to be safe--even when given to perinatally infected babies--continuation of the BCG immunization policies of the EPI is justified, especially in view of the growing incidence of tuberculosis as a complication of HIV infection.     

Tuberculosis screening results made at primary schools in Cizre

Tuberculosis (Tbc) gained importance as a public health problem in the recent years. The course of the disease is more severe in childhood. Tbc screening was made by The Tuberculosis Control 11th Group Presidency on the primary school students in Cizre, in November 2005. A total of 2242 children have been taken to this study. Of the children, 1130 (50.4%) were boys and 1112 (49.6%) were girls. The mean age of the children was 6.9+/-0.8 (range, 4-14) years. Concerning Bacillus Calmette-Guerin (BCG) vaccine scar, 1676 (74.7%) children had no scar, 536 children (23.9%) had single scar, and 32 children (1.4%) had double scar. The mean diameter of the tuberculin skin test (TST) was 2.1+/-2.7 mm. Regarding sexuality and TST mean diameter, statistically significant relation was not detected between girls and boys (p=0.3). The mean diameter of TST were 1.5+/-1.4 mm, 3.5+/-4.0 mm and 11.2+/-3.3 mm in the children with no BCG scar, in those with single BCG scar, and in those with double BCG scar, respectively. Of the TST results of all children, 2065 (92.1%) were negative, 101 (4.5%) were attributed to BCG, and 76 (3.4%) were positive, respectively. The rate of positiveness of TST was 1.2% in the children with no BCG scar, 8.9% in the children with single BCG scar, and 50% in the children with double BCG scar, respectively. A statistically significant correlation between the increase in the BCG scar number and the increase in the TST mean diameter was detected (p<0.05). Of the children who were likely to have Tbc, 139 (6.2%) were advised to apply at the dispensary. Single BCG vaccination was inadequate in the children. We suggest encouraging the families about postpartal single BCG vaccination. Furthermore, school screenings should be paid greater attention.     

Absence of relationships between tuberculin responses and development of adult asthma with rhinitis and atopy

OBJECTIVE: To investigate the relationship between tuberculin skin responses and the development of adult asthma, rhinitis, and atopy. METHODS: Two hundred fourteen patients with mild-to-moderate asthma accompanied with rhinitis and 220 normal volunteers underwent a medical history, chest radiography, allergen skin-prick testing (SPT), bovine Mycobacterium tuberculosis vaccine (BCG) scar identification, purified protein derivative (PPD) tuberculin skin testing, serum-total and serum-specific IgE measurements, and bronchial provocation (provocative dose of histamine causing a 20% fall in FEV(1) [PD(20)]). RESULTS: Thirty-one normal volunteers (14.1%) and 168 asthma-rhinitis subjects (78.5%) had one or more positive skin test results (p < 0.0001). Neither the presence of a BCG scar nor a history of BCG vaccination had a significant effect on atopy in either group. The rate of PPD positivity had no statistical difference between atopy and nonatopy in both groups. In multivariate logistic regression analysis, the odds ratio for tuberculin reactivity was not related to the level of serum-total IgE nor to the level of serum-specific IgE to Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF), skin response to DP and DF, and PD(20). Overall, no significant correlations were found between tuberculin skin reactivity and log serum-total IgE or PD(20). CONCLUSION: There is no relationship between history of tuberculosis infection, tuberculin responses, and development of adult bronchial asthma, allergic rhinitis, and atopy. Our study suggests that the protection provided by intradermal BCG vaccination in infants to prevent atopic diseases may be limited in early childhood, when a substantial memory of cellular immune modulation still exists.     

Can BCG-vaccinated children be included in tuberculin surveys to estimate the annual risk of tuberculous infection in India?

SETTING: Selected villages in three defined zones of India. OBJECTIVES: To compare the estimated prevalence of tuberculous infection among children with and without bacille Calmette-Guérin (BCG) scar. STUDY DESIGN: During a nationwide tuberculin survey, 1-9-year-old children were tuberculin tested using 1TU-PPD RT23 with Tween 80. RESULTS: In the 5-9 year age group, subgroups of tuberculous infected children could be seen as distinct humps among those with or without BCG scar, but not in those aged 1-4 years. In children aged 1-4 years, the estimated prevalence of infection was respectively 3.5%, 3.8% and 3.6% among children without BCG scar, and 4.8%, 4.7% and 4.5% among children with BCG scar in the western, northern and eastern zones. In those aged 5-9 years, the estimated prevalence was respectively 10.4%, 11.0% and 9.1% among children without BCG scar and 11%, 11.9% and 8.7% among children with BCG scar in the three zones. Thus, in children aged 1-4 years, the estimated prevalence among those with BCG scar was considerably higher than in those without BCG scar. This difference was small in those aged 5-9 years. CONCLUSION: Tuberculin surveys may be conducted irrespective of BCG scar status among children aged 5-9 years, when BCG vaccination is given using Danish 1331 strain during infancy under the Expanded Program of Immunization.     

Prevalence and factors associated with tuberculosis infection among new school entrants, New York City, 1991-1993.

SETTING: New York City public (or state-run) and private schools-elementary and secondary. OBJECTIVE: To describe the prevalence and determine factors associated with positive tuberculin skin tests (TSTs) in school children. DESIGN: Mandatory TST surveys among cohorts of new school entrants for the 1991, 1992 and 1993 school years, of whom birthplace was known for 81%. A positive tuberculin skin test defined as > or =10 mm induration. RESULTS: Of the 298506 new school entrants, 2.1% (6326) were tuberculin test positive. The proportion that was tuberculin test positive was 0.5% (931/199 728) among US-born and 9.2% (3794/41 346) among foreign-born students. Foreign-born (FB) students with a history of BCG vaccination were much more likely to have a positive tuberculin test than US-born students (13.6% vs. 0.5%, odds ratio [OR] = 33.6, 95% confidence interval [CI] 31.7, 35.6), and were more likely to have a positive tuberculin test than FB students with no history of BCG (13.6% vs. 4.4%, OR = 3.4, 95% CI 2.5, 4.6). Older age was independently associated with tuberculin test positivity, except among foreign-born BCG-vaccinated children, in whom the youngest were more likely to have a positive tuberculin test. CONCLUSIONS: Even in the midst of a tuberculosis resurgence such as that experienced by New York City, where tuberculosis cases nearly tripled from 1978 to 1992, the risk of tuberculosis infection among school children remained quite low. Given the reduced predictive value of the tuberculin test among low risk children and the effects of BCG vaccination, many children (especially younger children) with positive tuberculin test results are probably not infected with Mycobacterium tuberculosis. To reduce unnecessary evaluation and treatment, routine tuberculin tests should be administered only to high risk groups such as older children from countries with high rates of tuberculosis.     

The influence of Calmette-Guérin bacillus immunization on the booster effect of tuberculin testing in healthy young adults

The booster or enhancement effect of repeated tuberculin skin testing in Calmette-Guérin bacillus (BCG)-vaccinated young adults was studied in 208 first-year medical, nursing, and medical technology students in Santiago, Chile, where BCG vaccine is usually administered at birth and at 6 and 14 yr of age. Thirty-three students had no BCG scar, 62 had one scar, 71 had two scars, and 42 had three scars. The mean age for each group was 19 yr. All students were healthy and had no known exposure to tuberculosis or history of tuberculosis or other mycobacterioses. The size in millimeters of induration of the first tuberculin reaction (PPD1) was clearly correlated with the number of BCG scars: 2.3 +/- 4.6 for no scars; 6.7 +/- 6.7 for one scar; 10.9 +/- 5.9 for two scars, and 13.2 +/- 5.3 for three scars. The second tuberculin reaction (PPD2), performed 2 wk later on the contralateral forearm, showed a marked increase in reactivity. The increase in reaction size was most evident in students who had BCG scars but who were initially PPD negative (less than 10 mm). Smaller increases were observed in students without BCG scars, and also in those who had BCG scars but who were initially tuberculin positive (greater than or equal to 10 mm). The persistence of the booster effect was evaluated by performing PPD3 1 yr later. PPD1-negative students with BCG scars maintained the increased level of reactivity to PPD2 after 1 yr. An immunizing effect of tuberculin testing was suggested in 11 nonimmunized students who were initially PPD negative.(ABSTRACT TRUNCATED AT 250 WORDS)     

Skin test reactivity to mycobacterial antigens parallels the phylogenetic structure of their genus.

SETTING: City of Manaus, Amazonas, Brazil. OBJECTIVE: To explore the relationship between positivity to tuberculin and other environmental mycobacteria sensitins, according to a range of criteria and presence of BCG scar. DESIGN: Dual skin testing with tuberculin and four mycobacterial sensitins, and BCG scar recording of 1070 schoolchildren aged 7-14. Four criteria for positivity were used: simple and dominant, with 5 and 10 mm cut-off points. RESULTS: The standardised prevalence of reactions > or = 5 mm for BCG scar negative children was 58.3% for Mycobacterium avium, 54.2% for M. scrofulaceum, 26.8% for M. fortuitum, 17.9% for M. tuberculosis and 7.6% for M. kansasii. Correlations between tuberculin and each sensitin, for BCG scar negative children, were 0.47 for M. avium, 0.53 for M. scrofulaceum, 0.60 for M. kansasii and 0.22 for M. fortuitum (all with P < 0.01). BCG effect was particularly significant for tuberculin (odds ratio = 3.44 for reactions > or = 5 mm, P < 0.001) and influenced the balance between dominant/non-dominant reactions for all sensitins. CONCLUSION: The correlation between tuberculin and each sensitin confirmed the separation of the rapidly (M. fortuitum) and slowly growing mycobacteria (M. tuberculosis, M. avium, M. scrofulaceum and M. kansasii). The influence of BCG on tuberculin reactions was more marked than on other mycobacterial sensitins.     

Annual risk of tuberculous infection in Khammam a tribal district of Andhra Pradesh

A tuberculin survey to estimate annual risk of tuberculosis was conducted in Khammam tribal district during 2001-2002. A total of 8637 children were test-read--2991 without BCG scar and 5442 with BCG scar. The tests were performed using ITU PPD RT23 and the maximum size of induration was recorded at about 72 hours after the test. Based on the frequency distribution of reaction size, cut-off point for infection with tubercle bacilli was considered at 12 mm. Using this criterion, the prevalence of infection was estimated at 11.8% among children without BCG scar and 10.6% among children with BCG scar. This difference was found to be statistically insignificant. ARTI rates computed from the prevalence estimates among children without and with BCG scar were 1.6% and 1.5% respectively. It was computed as 1.5% from the prevalence in the combined group i.e. irrespective of BCG scar status.     

The effect of bacille Calmette-Guérin vaccination at birth on tuberculin skin test reactivity in Ugandan children.

SETTING: In Uganda, bacille-Calmette Guerin (BCG) vaccination coverage at birth is between 82 and 84%. OBJECTIVE: To evaluate the effect of neonatal BCG vaccination on tuberculin skin test positivity in Ugandan children exposed to infectious cases. DESIGN: As part of an ongoing prevalence study of household contacts of new tuberculosis cases, 365 children were evaluated to determine if BCG vaccination at birth had an impact on tuberculin skin testing. The children were classified as contacts (179) and non-contacts (186) depending on the presence of a sputum acid-fast bacilli (AFB) smear-positive adult tuberculosis case in the household. RESULTS: Regardless of prior BCG vaccination, children exposed to a smear-positive adult were more likely to have a positive skin test (purified protein derivative >5mm) (68% versus 36%, P < 0.01). BCG-vaccinated children below 1 year of age without a known household contact with active tuberculosis had a lower frequency of tuberculin skin reactions (29%) compared to their counterparts in the contact households (65%, P = 0.031). CONCLUSION: BCG vaccination at birth had no important effect on the interpretation of the tuberculin skin test reactivity in this group of Ugandan children. The tuberculin skin test remains a valuable tool for the evaluation of household contacts and suspected cases of tuberculosis in BCG-vaccinated children.     

Effect of BCG vaccination and non-tuberculous Mycobacterium infection on interferon gamma specific assay and a tuberculin skin test among children with a tuberculosis contact in Surabaya, Indonesia

The tuberculin skin test (TST) as a diagnostic tool for tuberculosis (TB) infection is used in many countries, including Indonesia, but lacks specificity. Interferon-gamma is a highly specific assay because it is not influenced by previous BCG vaccination or non-tuberculous mycobacteria (NTM) infections. We aimed to study the effect of BCG vaccination and NTM infection on the results of the interferon-gamma specific assay and TST among children with a TB contact. We carried out a cross-sectional study of children at an outpatient clinic in Surabaya, Indonesia. We studied 37 children aged 1-15 years having a household contact with an acid-fast bacilli positive adult index case. BCG vaccination was determined by the presence of a BCG scar. A PPD RT23 2 tuberculin test was used for the TST. ESAT-6, CFP-10, and TB 7.7(p4) antigens were used for the interferon-gamma assay by ELISA. Gastric aspirates were cultured in Lowenstein-Jensen media. A comparison of the two diagnostic tools among children aged 1-5 years without a BCG scar, revealed high agreement, while children with a BCG scar it revealed disagreement. Among children aged > 5 years with or without a BCG scar the comparisons revealed disagreement. Among children aged > 5-10 years, a comparison of the two diagnostic tools among NTM positive and negative children, there was a disagreement in results. Among children aged 1-5 years, the TST was influenced by a BCG scar. Infection with NTM had no influence on the results of the TST among children aged > 5-10 years, while in children aged 1-5 years and > 10 years the results could not be determined in this study.     

Evaluation of BCG at birth in the United Arab Emirates

A total of 387 healthy full term infants who received BCG vaccination at birth were evaluated by the tuberculin PPD test at 6-8 weeks post vaccination. A total of 92% of these infants had visible BCG scars at that time. All infants were tested with PPD but only 264 returned for the test to be read. The tuberculin test was negative in 37 (14%) and of less than 5 mm induration in another 60 (23%) of the infants. The same pattern was observed in different nationalities. Of 11 infants with no BCG scar after vaccination, 3 had positive PPD reactions of more than 5 mm induration. There was a significant correlation between the size of the BCG scar and induration of tuberculin test P less than 0.001. The complications of the vaccination were minimal. We have observed 3 sterile abscesses at the site of BCG vaccination which resolved spontaneously. We think the available vaccine is safe and potent, and that the rate of BCG scar formation and of tuberculin conversion is higher than in most studies.     

Annual risk of tuberculous infection in the western zone of India.

SETTING: Rural and urban areas of six selected districts in the western zone of India. OBJECTIVES: To estimate the annual risk of tuberculous infection (ARI). DESIGN: A community-based, cross-sectional tuberculin survey was conducted among children aged 1-9 years residing in a sample of rural and urban areas of six districts in the western zone of India. Stratified two-stage cluster sampling was adopted for selection of rural and urban clusters. A total of 48473 children in 600 clusters underwent tuberculin testing with 1TU PPD RT23 with Tween 80; the induration was measured about 72 h after the test. RESULTS: The BCG scar was observed in 52% of the test-read children. Estimation of the prevalence of infection was based on the frequency distribution of tuberculin reaction size among 22259 children without BCG scar. Reactions > or = 15 mm were considered attributable to infection with tubercle bacilli. The prevalence of infection was estimated to be 9.3%, and the ARI computed from the estimated prevalence was 1.8%. The proportion of infected children was found to be significantly higher in urban than in rural areas. CONCLUSION: The high rate of ARI in the western zone of India calls for further intensification of tuberculosis control efforts.     

Stimulation of lung growth in fetuses with lung hypoplasia leads to altered postnatal lung structure in sheep

Our objective was to describe the respiratory complications, clinical findings, and chest radiographic changes in the first year of life in infected and uninfected children born to HIV-1-infected women. We prospectively followed a cohort of 600 infants born to HIV-1-infected women from birth to 12 months in a multicenter study. Of these, 93 infants (15.5%) were HIV-1-infected, 463 were uninfected, and 44 were of unknown status prior to death or loss to follow-up. The cumulative incidence ( +/- SE) of an initial pneumonia episode at 12 months was 24.1 +/- 4.7% in HIV-1-infected children compared to 1.4 +/- 0.6% in HIV-1-uninfected children (P < 0.001). The rate of Pneumocystis carinii pneumonia (PCP) was 9.5 per 100 child-years. The HIV-1 RNA load was not higher in the group that developed pneumonia in the first year vs. those who did not. Children who developed lower respiratory tract infections or PCP had increased rates of decline of CD4 cell counts during the first 6 months of life. Lower maternal CD4 cell counts were associated with higher rates of pneumonia, and upper and lower respiratory tract infections. The rates of upper respiratory tract infection and bronchiolitis/reactive airway disease in infected children were not significantly different than in uninfected children. At 12 months, significantly more HIV-1-infected than uninfected children had tachypnea and chest radiographs with nodular and reticular densities. There was no relationship between cytomegalovirus infection in the first year of life and radiographic changes or occurrences of pneumonia. In conclusion, despite a low incidence of PCP, rates of pneumonia remain high in HIV-infected children in the first year of life. The incidence of pneumonia in uninfected infants born to HIV-1-infected mothers is low. Chest X-ray abnormalities and tachypnea suggest that subacute disease is present in infected infants. Further follow-up is warranted to determine its nature.     

Comparative skin testing with PPD tuberculin,Mycobacterium avium and M. scrofulaceum sensitin in schoolchildren in Saudi Arabia

Setting: Jizan region, Saudi Arabia.Objective: To test methodology for studies of tuberculin sensitivity and effectiveness of BCG vaccination programme.Design: School children (n = 315) aged 6–12 years simultaneously tested intradermally with PPD tuberculin RT23, 2TU and 0.1 μg Mycobacterium avium or M. scrofulaceum sensitin. Presence of BCG scar as evidence of previous BCG vaccination. Cervical lymph nodes palpated.Results: BCG coverage was 75%. The prevalences of positive reactions (induration ⪰ 6mm) were higher among children with than without scar. Prevalences of positive reactions to PPD and M. scrofulaceum sensitin were higher among girls than boys. In children with scar, the mean size of positive reactions to PPD was larger among girls than boys, and the prevalence of positive reactions was smaller in this group among children with than without palpable cervical lymph nodes. The sizes of reactions both to M. avium and to M. scrofulaceum sensitin were correlated to the size of the tuberculin reactions. Previous admission to hospital was reported less often by children with than without scar.Conclusions: The technique applied and training of staff was satisfactory. In further studies, however, we will apply three simultaneous tests to each person.     

BCG scars in northern Malawi: sensitivity and repeatability of scar reading, and factors affecting scar size.

SETTING: Karonga district, northern Malawi. OBJECTIVE: To assess the sensitivity and repeatability of BCG scar reading, and factors affecting scar size. DESIGN: Follow-up of individuals aged > 3 months who were recruited into a BCG vaccine trial (1986-1989), and of infants vaccinated in health centres (1989-1991), who were examined for presence and size of BCG scars in subsequent years. All examinations were carried out blind of information on true vaccination status or the results of previous examinations. RESULTS: For trial individuals who were considered scar negative at recruitment and received BCG, the sensitivity of scar reading was > or = 93%, repeatability was > or = 94% for those < 60 years old at vaccination, and only around 1% were assessed as having > 1 BCG scar post-vaccination. For infants vaccinated when < 1 month old in health centres, the proportion who still had recognisable scars 4 years later was < 80%. Scars were larger in individuals with a prior BCG vaccination, and for those aged 15-59 at vaccination the scars were approximately 1 mm larger for males than for females. CONCLUSIONS: A BCG scar is a highly sensitive and repeatable indicator of vaccination status when the vaccine is properly handled, delivered appropriately, and given at over 3 months of age, but not for vaccinations given within 1 month of birth. Given that most vaccinations in the world are given soon after birth, this low sensitivity will lead to both vaccine coverage and vaccine efficacy being underestimated in studies in which vaccination status is inferred from the presence/absence of a distinctive BCG scar. Age-sex patterns identified for scar size show important similarities to those found with skin test responses to tuberculin.     

BCG scar and tuberculin reactivity in children and adults

Bacille Calmette-Guérin (BCG) vaccination generally leads to scar formation and tuberculin skin test (TST) reactivity. This study aimed at analysing these 2 parameters and their correlation in a setting with a low prevalence of tuberculosis. Retrospectively, we analysed 314 children and 390 adults living in Sweden and known from records or individual recall to have undergone BCG vaccination. A BCG scar was present in 161 (51%) of the children and in 340 (87%) of the adults. Among children with a scar, 94 (58%) were TST-positive (>or=6 mm) compared to 23 (15%) of 154 children lacking a visible scar. Among adults with a scar, 258 (76%) were TST- positive compared to 23 (46%) of 50 with no scar. Out of 152 non-vaccinated adults, 142 (94.4%) were TST-negative. When 175 TST-negative health care students were BCG-vaccinated in a prospective part of the study, 174 (99%) were found to develop a scar. In essence, the study showed a positive correlation between scar presence and TST reactivity. Furthermore, BCG vaccination of adults in the present setting resulted in consistent scar formation, while scar prevalence in previously vaccinated children was low.     

Annual risk of tuberculous infection in rural areas of Uttar Pradesh, India.

SETTING: Rural areas in Uttar Pradesh, the most populous state in India. OBJECTIVES: 1) To estimate the average annual risk of tuberculous infection (ARI), 2) to study ARI trends with age, and 3) to compare tuberculin reactions among children with and without BCG scar. STUDY DESIGN: A cross-sectional tuberculin survey was conducted among children aged 1-9 years residing in Rae Bareli, Hardoi and Jaunpur districts, Uttar Pradesh. Tuberculin testing was performed using 1TU of PPD RT23 with Tween 80, and indurations were measured 72 hours later. Prevalence of infection was estimated in children without BCG scar based on the cut-off point identified on the frequency distribution of reaction sizes. The ARI was computed from the estimated prevalence. RESULTS: The proportion of children with BCG scar varied from 25% to 31% in the study districts. Using a cut-off of 14 mm among children without BCG scar, the ARI was estimated at 2.3% in Rae Bareli, 1.9% in Hardoi and 1.5% in Jaunpur, and was observed to increase with age. Tuberculin test results among children with BCG scar suggest that they may be included in tuberculin surveys to estimate ARI. CONCLUSION: High rates of transmission of tuberculous infection suggest that tuberculosis control measures need to be intensified.     

Analysis of tuberculin reaction of tuberculous children below 4 years of age]

To clarify whether the size of tuberculin reaction could be used as an useful index of the severity of tuberculosis, we analyzed the sizes of tuberculin reaction (TR) of 60 children below 4 years of age with active tuberculosis at the time of diagnosis. Of 60 patients, 53 (88.9%) had positive reactions to tuberculin. The mean size of TR of 60 patients was 24.0 +/- 13.9 mm and maximum size was 60 mm. Seven patients who had no reaction to the tuberculin skin test consisted of three primary complex and four serious tuberculosis (two miliary tuberculosis and two tuberculous meningitis). The patients without BCG vaccination showed significantly smaller TR than the patients with BCG vaccination (p < 0.05). The patients less than 1 year of age showed significantly smaller TR than the patients of 4 years of age (p < 0.05). The patients with serious tuberculosis showed significantly smaller TR than the patients with primary complex (p < 0.05). Of patients with primary complex, there were no difference of the size of TR between the patients with pulmonary tuberculosis (III) and hilar lymphadenopathy (H). Together with, it did not necessarily mean that negative TR showed no infection with tuberculosis and the sizes of TR depended on the severity of tuberculosis in infantis and young children.     

铜陵市婴幼儿卡介菌纯蛋白衍生物试验结果分析

目的了解卡介苗（BCG）预防接种质量,分析存在的问题及其影响因素,提出改进措施,促进预防接种规范、安全、有效地开展。方法用卡介菌纯蛋白衍生物（BCG-PPD）试验方法,随机调查300名儿童接种卡介苗3个月后的阳转率。结果卡介菌纯蛋白衍生物试验总阳性率86.33%,城市儿童卡介菌纯蛋白衍生物试验阳性率高于农村儿童。卡痕大小与卡介菌纯蛋白衍生物试验阳性率呈正相关;县级及以上医院产科接种卡介苗的儿童卡介菌纯蛋白衍生物试验阳性率高于乡镇级医院产科和预防接种门诊接种卡介苗的儿童。结论加强对卡介苗接种人员,尤其要加强农村乡镇卫生院和接种门诊的接种人员的技术培训,提高接种质量。     

QuantiFERON-TB Gold test for screening latent tuberculosis infection in hemodialysis patients

Hemodialysis patients are at increased risk of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in hemodialysis patients. The aim of this study is to determine whether the QFT-G is more sensitive than the TST in hemodialysis patients in LTBI. Eighty nine hemodialysis patients were evaluated for latent tuberculosis infection with the TST and QFT-G. Blood was obtained for QFT-G, and then TST was administered to all patients. Demographic information, laboratory tests, chest radiography results and BCG vaccination status were collected on standardized patient medical files. Forty patients had positive QFT-G results. 56 patients had TST induration above 5 mm, 28 patients above 10 mm. 61 patients had BCG vaccination scar. Statistically significant correlation was detected between TST and QFT-G (p< 0.05). In the BCG non-vaccinated subgroup, TST was positive in 8 (29%) patients and the QFT-G was positive in 11 (39%). Among the 21 non vaccinated patients with results for both tests, the concordance between the TST and QFT-G was 82%, k= 0.61, p= 0.001. We found good agreement between the TST and QFT-G test for LTBI in non vaccinated hemodialysis patients, whereas we found poor agreement in vaccinated patients. Because BCG vaccination is widely used in our country, the QFT-G test might be more useful for the diagnosis of LTBI than TST in hemodialysis patients who are suspected to have LTBI.