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The tuberculin skin test in relation to immunological in vitro reactions in BCG-vaccinated healthcare workers

¹ Dept of Respiratory Medicine and Allergology, and ² Dept of Microbiology and Immunology, Sahlgrenska University Hospital, Göteborg, Sweden

CORRESPONDENCE: H. Fjällbrant, Dept of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden. Fax: 46 31824904

Keywords: Bacille Calmette-Guérin vaccine, cellular immunity, occupational diseases, tuberculin test

Received: October 5, 2000
Accepted April 4, 2001

This study received generous financial support from the Oscar and Hanna Björkbom Fund and the Swedish Heart and Lung Foundation.

The aim was to study the tuberculin skin test in relation to immunological in vitro reactions in bacille Calmette-Guérin (BCG)-vaccinated healthcare workers.

The present study was performed in Sweden, a country with a low incidence of tuberculosis, a high BCG vaccination efficacy and high tuberculin conversion rates. BCG-vaccinated healthcare workers (n=381) were tuberculin skin tested. From these, 11 subjects with negative tuberculin reactions (<6 mm) were matched for age and sex with 11 subjects with large positive reactions (15 mm). Lymphocyte transformation and the production of interferon-gamma (IFN-) were analysed after stimulation in vitro of peripheral blood mononuclear cells with tuberculin purified protein derivative, heat-killed tubercle bacilli and a culture filtrate from tubercle bacilli.

In the tuberculin-positive group the lymphocyte transformation response was 2–3 times larger, and IFN- production was 7–10 times larger, than in the tuberculin-negative group (p<0.001).

The present results suggest that a positive tuberculin skin test in bacille Calmette-Guérin-vaccinated subjects indicates a stronger immune response of the protective T-helper 1-type than does a negative test. In similar settings, the study supports the traditional practice of regarding the tuberculin skin test in bacille Calmette-Guérin-vaccinated subjects as an indicator of a protective immune response against tuberculosis.