Browse > Article

Tuberculin Survey to Estimate the Prevalence of Tuberculosis Infection of the Elementary Schoolchildren under High BCG Vaccination Coverage  

Kim, Hee Jin (Korean Institute of Tuberculosis, The Korean National Tuberculosis Association)
Oh, Soo Yeon (Korean Institute of Tuberculosis, The Korean National Tuberculosis Association)
Lee, Jin Bum (Korean Institute of Tuberculosis, The Korean National Tuberculosis Association)
Park, Yun Sung (Division of HIV & Tuberculosis Control, Korea Centers for Disease Control and Prevention)
Lew, Woo Jin (Korean Institute of Tuberculosis, The Korean National Tuberculosis Association)
Publication Information
Tuberculosis and Respiratory Diseases / v.65, no.4, 2008 , pp. 269-276 More about this Journal
Abstract
Background: Although the prevalence of tuberculosis infections (PTBI) is one of the basic epidemiologic indices, no survey has been carried out since 1995 because the nation-wide tuberculosis prevalence survey was changed to a surveillance system. Subjects without a BCG scar are examined in a tuberculin survey. However, it is very difficult to select these subjects under high vaccination coverage. It is important to evaluate the impact of BCG vaccinations on the tuberculin response and estimate the PTBI regardless of the BCG vaccination status. Methods: A nation-wide, school-based cross-sectional tuberculin survey was carried out among first graders in elementary school in 2006. A total of 5,148 children in 40 schools were selected by quota sampling. Tuberculin testing with 0.1 ml of two tuberculin units of PPD RT23 was carried out on 4,018 children. The maximum transverse diameter of induration was measured 48 to 72 hours later. The presence of a BCG scar was checked separately. Results: There were no BCG scars in 6.3% of the subjects. The mean induration size of tuberculin testing was $3.7{\pm}4.4mm$, which included 1,882 (46.8%) subjects with an induration size of 0 mm. The PTBI was 10.9% (439 subjects) using a cut-off point of ${\geq}10mm$ (conventional method). The annual risk of tuberculosis infections (ARTI) was 1.9% when the mean age of the subjects was assumed to be 6 years. There was no difference in the PTBI according to the presence or absence of a BCG scar [11.2% vs 7.6% (OR: 1.54, 95% CI: 0.98~2.43)]. Using a mirror image technique with 16 mm as the cut-off point, the PTBI and ARTI had decreased to 2.4% and 0.4% respectively. Conclusion: PTBI and ARTI, as estimated by conventional methods, appear to be high among BCG vaccinated children. A mirror image technique is more suitable for estimating the indices in a country with an intermediate burden of tuberculosis than the conventional method.
Keywords
Tuberculosis; Tuberculin test; Infection;
Citations & Related Records
연도 인용수 순위
1 Bleiker MA. The annual tuberculosis infection rate, the tuberculin survey and the tuberculin test. Bull Int Union Tuberc Lung Dis 1991;66:53-6.
2 Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis 2006;10:1192-204.
3 American Thoracic Society. Tuberculin skin test. Am Rev Respir Dis 1981;124:356-63.
4 Wang L, Turner MO, Elwood RK, Schulzer M, FitzGerald JM. A meta-analysis of the effect of Bacille Calmette Guerin vaccination on tuberculin skin test measurements. Thorax 2002;57:804-9.   DOI
5 Chadha VK, Jagannatha PS, Kumar P. Can BCG-vaccinated children be included in tuberculin surveys to estimate the annual risk of tuberculous infection in India? Int J Tuberc Lung Dis 2004;8:1437-42.
6 Gopi PG, Subramani R, Nataraj T, Narayanan PR. Impact of BCG vaccination on tuberculin surveys to estimate the annual risk of tuberculosis infection in south India. Indian J Med Res 2006;124:71-6.
7 Gopi PG, Subramani R, Santha T, Kumaran PP, Kumaraswami V, Narayanan PR. Relationship of ARTI to incidence and prevalence of tuberculosis in a district of south India. Int J Tuberc Lung Dis 2006;10:115-7.
8 Menzies D. What does tuberculin reactivity after bacille Calmette-Guerin vaccination tell us? Clin Infect Dis 2000;31:S71-4.   DOI   ScienceOn
9 The Ministry of Health and Social Affairs, The Korean National Tuberculosis Association. Report on the 6th National tuberculosis prevalence survey. Seoul, Republic of Korea: The Korean National Tuberculosis Association; 1991.
10 The Ministry of Health and Welfare, The Korean National Tuberculosis Association. Report on the 7th National tuberculosis prevalence survey. Seoul, Republic of Korea: The Korean National Tuberculosis Association; 1996.
11 Arnadottir T, Rieder HL, Trébucq A, Waaler HT. Guidelines for conducting tuberculin skin test surveys in high prevalence countries. Tuber Lung Dis 1996;77 Suppl 1:1-19.
12 Harada N. Characteristics of a diagnostic method of tuberculosis infection based on whole blood interferon- gamma assay. Kekkaku 2006;81:681-6.
13 Leung CC, Yew WW, Tam CM, Chan CK, Chang KC, Law WS, et al. Tuberculin response in BCG vaccinated schoolchildren and the estimation of annual risk of infection in Hong Kong. Thorax 2005;60:124-9.   DOI   ScienceOn
14 Al-Jahdali H, Memish ZA, Menzies D. The utility and interpretation of tuberculin skin tests in the Middle East. Am J Infect Control 2005;33:151-6.   DOI   ScienceOn
15 Smeja C, Brassard P. Tuberculosis infection in an Aboriginal (First Nations) population of Canada. Int J Tuberc Lung Dis 2000;4:925-30.