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The impact of BCG vaccination on tuberculin skin test responses in children is age dependent: evidence to be considered when screening children for tuberculosis infection

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Title: The impact of BCG vaccination on tuberculin skin test responses in children is age dependent: evidence to be considered when screening children for tuberculosis infection
Authors: Seddon, JA
Paton, J
Nademi, Z
Keane, D
Williams, B
Williams, A
WElch, SB
Liebeschutz, S
Riddell, A
Bernotoniene, J
Patel, S
Martinez-Alier, N
McMaster, P
Kampmann, B
Item Type: Journal Article
Abstract: Background Following exposure to TB, contacts are screened to target preventive treatment at those at high risk of developing TB. The UK has recently revised its recommendations for screening and now advises a 5 mm tuberculin skin test (TST) cut-off irrespective of age or BCG status. We sought to evaluate the impact of BCG on TST responses in UK children exposed to TB and the performance of different TST cut-offs to predict interferon γ release assay (IGRA) positivity. Methods Children <15 years old were recruited from 11 sites in the UK between January 2011 and December 2014 if exposed in their home to a source case with sputum smear or culture positive TB. Demographic details were collected and TST and IGRA undertaken. The impact of BCG vaccination on TST positivity was evaluated in IGRA-negative children, as was the performance of different TST cut-offs to predict IGRA positivity. Results Of 422 children recruited (median age 69 months; IQR: 32–113 months), 300 (71%) had been vaccinated with BCG. BCG vaccination affected the TST response in IGRA-negative children less than 5 years old but not in older children. A 5 mm TST cut-off demonstrated good sensitivity and specificity in BCG-unvaccinated children, and an excellent negative predictive value but was associated with low specificity (62.7%; 95% CI 56.1% to 69.0%) in BCG-vaccinated children. For BCG-vaccinated children, a 10 mm cut-off provided a high negative predictive value (97.7%; 95% CI 94.2% to 99.4%) with the positive predictive value increasing with increasing age of the child. Discussion BCG vaccination had little impact on TST size in children over 5 years of age. The revised TST cut-off recommended in the recent revision to the UK TB guidelines demonstrates good sensitivity but is associated with impaired specificity in BCG-vaccinated children.
Issue Date: 22-Jun-2016
Date of Acceptance: 28-Mar-2016
URI: http://hdl.handle.net/10044/1/30980
DOI: https://dx.doi.org/10.1136/thoraxjnl-2015-207687
ISSN: 1468-3296
Publisher: BMJ Publishing Group
Start Page: 932
End Page: 939
Journal / Book Title: Thorax
Volume: 71
Copyright Statement: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: SRF-2009-02-07
Keywords: Paediatric Lung Disaese
Respiratory Infection
Tuberculosis
Respiratory System
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Department of Medicine
Faculty of Medicine



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