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Free Content Tuberculin skin test reactivity of health care students in a country with a low prevalence of tuberculosis

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SETTING: Health care students in Sweden.

OBJECTIVE: To analyse the distribution of tuberculin skin test (TST) reactions and epidemiological factors related to TST reactivity.

DESIGN: TST reactivity was analysed in 1190 students. A linear regression model was created for the relative contribution of background factors of TST reactivity. A subgroup of 287 non-vaccinated subjects was comparatively skin-tested with Mycobacterium avium sensitin and tuberculin.

RESULTS: Among non-bacille Calmette-Guérin (BCG) vaccinated students, 91% had no TST reaction (0 mm induration) and reactions of ≥10 mm were found in 2.9%, whereas 34% of BCG-vaccinated students had no TST reaction and 42% had reactions of ≥10 mm. The expected contribution to TST reactivity was 6.0 mm for a history of BCG vaccination, 3.0 mm for a country of birth with medium/high incidence of TB and 1.6 mm per 10 years of age. The sensitin reactions exceeded the TST reactions by ≥3 mm in 52% of the comparatively tested subjects with TST reactions of ≥1 mm.

CONCLUSION: BCG vaccination, cross-reactivity with non-tuberculous mycobacteria, geographic origin and age had a decisive influence on TST reactivity. Most non-vaccinated health care students were non-reactive, which highlights the need to organise preventive measures in settings where TB exposure is expected.
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Keywords: bacille Calmette-Guérin vaccine; latent tuberculosis infection; non-tuberculous mycobacteria; occupational diseases; tuberculin skin test

Document Type: Regular Paper

Affiliations: 1: Department of Respiratory Medicine and Allergology, Institute of Internal Medicine, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden 2: Department of Microbiology and Immunology, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden 3: Department of Medicine, Division of Respiratory Medicine, Karolinska University Hospital, Stockholm, Sweden

Publication date: 2010-10-01

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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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