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IJE Advance Access published online on September 28, 2006
International Journal of Epidemiology, doi:10.1093/ije/dyl213
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2006; all rights reserved.
Accepted August 30, 2006

Original paper

Is tuberculin skin testing useful to diagnose latent tuberculosis in BCG-vaccinated children?

F. Ma. Cecilia García-Sancho 1, Lourdes García-García 2 *, Ma. Eugenia Jiménez-Corona 2, Manuel Palacios-Martínez 2, Leticia D. Ferreyra-Reyes 2, Sergio Canizales-Quintero 2, Bulmaro Cano-Arellano 2, Alfredo Ponce-de-León 3, José Sifuentes-Osornio 3, Peter Small 4, and Kathryn DeRiemer 5

1 Instituto Nacional de Salud Pública (INSP), 7a. Cerrada de Fray Pedro de Gante No. 50 Col. Sección XVI, Deleg. Tlalpan, C.P. 14000, Mexico, D.F., Mexico; Instituto Nacional de Enfermedades Respiratorias (INER), Calzada Tlalpan 4502, Col. Sección XVI, Delegación Tlalpan, C.P. 14080, Mexico, D.F., Mexico
2 Instituto Nacional de Salud Pública (INSP), 7a. Cerrada de Fray Pedro de Gante No. 50 Col. Sección XVI, Deleg. Tlalpan, C.P. 14000, Mexico, D.F., Mexico
3 Instituto Nacional de Ciencias Médicas y Nutrición (INCMNSZ), Vasco de Quiroga XX, Col. Sección XVI, Delegación Tlalpan, C.P. 14000, Mexico, D.F., Mexico
4 Bill and Melinda Gates Foundation, Seattle, Washington, USA
5 University of California, Davis School of Medicine, One Shields Avenue Davis, CA 95616, USA

* To whom correspondence should be addressed.
Lourdes García-García, E-mail: garcigarml{at}gmail.com


  Abstract

Background The tuberculin skin test (TST) is the most commonly used tool to detect infection with Mycobacterium tuberculosis. We sought to determine whether tuberculin skin testing is useful to detect latent infection by M. tuberculosis in a population that was vaccinated with the Bacille Calmette Guérin (BCG) vaccine.

Methods We performed a cross-sectional study during October 2000-February 2001, enrolling first and sixth graders from a random, stratified sample of public elementary schools in Orizaba, Veracruz, Mexico. We assessed the relationship between sociodemographic and epidemiological information, BCG scars, and TST reactivity.

Results There were 858 children enrolled in the study with a completed questionnaire and TST result. The prevalence of a positive TST result (≥10 mm) was 12.4%. Controlling for BCG scar, age, and other characteristics, close contact with pulmonary tuberculosis patients (odds ratio 6.56, 95% confidence interval 2.05-21.07, P = 0.001) was independently associated with TST reactivity.

Conclusions TST results helped identify children in a BCG-vaccinated population who had recent exposure to persons with pulmonary tuberculosis, were probably infected with M. tuberculosis, and could benefit from treatment for their latent tuberculosis infection.

Keywords: Mycobacterium tuberculosis; latent infection; tuberculin skin test; Bacille Calmette Guérin (BCG) vaccine.
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