Authors: Levy, M.Z.¹; Medeiros, E.A.S.²; Shang, N.³; Soares, M.C.S.²; Homenko, A.S.²; Almeida, R.M.²; Garrett, D.O.⁴; Roth, V.R.⁵; Jarvis, W.R.⁶; Wells, C.D.³; Binkin, N.⁷; Laserson, K.F.³

Source: The International Journal of Tuberculosis and Lung Disease, Volume 9, Number 7, July 2005 , pp. 771-776(6)

Publisher: International Union Against Tuberculosis and Lung Disease

Abstract:

SETTING: A major university in São Paulo, Brazil, where vaccination against tuberculosis (TB) with bacille Calmette-Guérin (BCG) was routinely offered to first-year medical and nursing students.

OBJECTIVES: To estimate the probability of negative tuberculin skin test (TST) results over a 4-year period following BCG revaccination, and to evaluate the effect of factors associated with reversion.

DESIGN: Students were enrolled in 1997, initially given a two-step TST, and were retested annually or biannually for the duration of the study. Data on TB exposures and potential risk factors for TST negativity and reversion were collected through annual surveys. A linear mixture survival model was used to estimate the probability of negative TST results over time.

RESULTS: Of 159 students, an estimated 20% had a negative TST result despite revaccination, and a further 31% reverted to negative over 4 years of follow-up. No cofactors significantly affected the probability of reversion.

CONCLUSION: Overall, in the absence of reported exposure to Mycobacterium tuberculosis, 51% of students revaccinated upon entering nursing or medical school would have a negative TST result by the time they begin their internships. In this recently vaccinated population, reversion was common, suggesting that annual TST screening may remain a useful tool.

Keywords: tuberculosis; BCG; tuberculin skin test; Brazil

Document Type: Regular paper

Affiliations: 1: Program in Population Biology, Evolution, and Ecology, Emory University, Atlanta, Georgia, USA 2: Disciplina de Doenças Infecciosas e Parasitárias, Comissão de Epidemiologia Hospitalar, Universidade Federal de São Paulo, Brazil 3: Division of Tuberculosis Elimination, National Center for HIV, STD and TB Prevention (NCHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia, USA 4: National Program for TB Control, Secretariat of Health Surveillance, Ministry of Health, Brasilia, Brazil 5: Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and Infection Prevention and Control Department, The Ottawa Hospital, Ottawa, Ontario, Canada 6: Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA 7: Division of Tuberculosis Elimination, National Center for HIV, STD and TB Prevention (NCHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and Instituto Superiore di Sanità, Rome, Italy

Publication date: 2005-07-01

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• The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

  Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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• By this author: Levy, M.Z. ;  Medeiros, E.A.S. ;  Shang, N. ;  Soares, M.C.S. ;  Homenko, A.S. ;  Almeida, R.M. ;  Garrett, D.O. ;  Roth, V.R. ;  Jarvis, W.R. ;  Wells, C.D. ;  Binkin, N. ;  Laserson, K.F.

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