The value of counting BCG scars for interpretation of tuberculin skin tests in a tuberculosis hyperendemic shantytown, Peru.

摘要: Tuberculosis (TB) is of major importance in developing countries. Ninety-five per cent tuberculosis cases and 98% deaths are countries, 75% these the economically productive age group.1 Poverty, poorer health care, migration make TB control difficult In industrialized a large percentage among recent immigrants. United States, for example, nearly 50% immigrants.2 Although Peru has recently been removed from World Health Organization's (WHO) list 23 highburden still problem this country.3 The reported incidence 2000 was 134 100 000 population;4 however, WHO estimates annual at 228/100 000,3 epidemiological studies Lima shantytown have demonstrated even higher incidences (364/100 000).5 Recent shown that bacille Calmette-Guerin (BCG) effective prevention tuberculous meningitis disseminated TB, but its protective effect against pulmonary controversial.6,7 results randomized trial multiple BCG vaccination show no benefit two or more vaccinations.8 Since 1995 recommended single dose vaccine soon after birth all countries with high infection.9 However, vaccines given 39 intermediate- high-incidence as part their standard programs.10 Peru's national program undergone numerous modifications. initiated 1962 originally included one intradermal newborns (0.1 mg live bacillus 0.1 ml, Pasteur Institute, Paris, France). modified 1970s to include three vaccinations 5-year intervals up 15, it thought immunity provided by wanes within 5 years. third vaccination, dropped 1979, second, 10, finally 1996. program, administered erratically. The purpose our study analyze on tuberculin skin test (TST) reaction size an endemic, community-based setting. Several examined effects TST size.11-18 None household surveys, thus could not assess contact person TST-positive (Table 1). Two Canada Philippines, which active case considered independent risk factor adjustment, failed demonstrate vaccinations.12,15 absence significant studies, may be due limited sample size. Table 1 Studies