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Published online before print February 15, 2006, 10.1183/09031936.06.00107005
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Eur Respir J 2006; 28:16-23
Copyright ©ERS Journals Ltd 2006

Avoiding the effect of BCG vaccination in detecting Mycobacterium tuberculosis infection with a blood test

R. Diel1, M. Ernst2, G. Döscher3, L. Visuri-Karbe4, U. Greinert3, S. Niemann5, A. Nienhaus6 and C. Lange3

1 School of Public Health, University of Düsseldorf, Düsseldorf, 2 Division of Immune Cell Analysis, 3 Division of Clinical Infectious Diseases, 5 Division of Mycobacteriology, Research Center Borstel, Borstel, 4 Medical Service, Police Academy Schleswig-Holstein, Eutin, and 6 Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany.

CORRESPONDENCE: C. Lange, Medical Clinic, Research Center Borstel, Parkallee 35, 23845 Borstel, Germany. Fax: 49 4537188313. E-mail: clange{at}fz-borstel.de

Keywords: Contact tracing, early secretory antigenic target 6, enzyme-linked immunospot assay, interferon-{gamma}, latent tuberculosis infection, tuberculosis

Received: September 12, 2005
Accepted February 7, 2006

Bacille Calmette–Guérin (BCG) vaccination can confound tuberculin skin test (TST) reactions in the diagnosis of latent tuberculosis infection (LTBI).

The TST was compared with a Mycobacterium tuberculosis (MTB)-specific enzyme-linked immunospot (ELISPOT) assay during an outbreak of MTB infection at a police academy in Germany.

Participants were grouped according to their risk of LTBI in close (n = 36) or occasional (n = 333) contacts to the index case. For the TST, the positive response rate was 53% (19 out of 36) among close and 16% (52 out of 333) among occasional contacts. In total, 56 TST-positive contacts (56 out of 71 = 78.9%) and 27 TST-negative controls (27 out of 298 = 9.1%) underwent ELISPOT testing. The odds ratio (OR) of a positive test result across the two groups was 29.2 (95% confidence interval (CI) 3.5–245.0) for the ELISPOT and 19.7 (95% CI 2.0–190.2) for the TST with a 5 mm cut-off. Of 369 contacts, 158 (42.8%) had previously received BCG vaccination. The overall agreement between the TST and the ELISPOT was low, and positive TST reactions were confounded by BCG vaccination (OR 4.8 (95% CI 1.3–18.0)). In contrast, use of a 10-mm induration cut-off for the TST among occasional contacts showed strong agreement between TST and ELISPOT in nonvaccinated persons.

In bacille Calmette–Guérin-vaccinated individuals, the Mycobacterium tuberculosis-specific enzyme-linked immunospot assay is a better indicator for the risk of latent tuberculosis infection than the tuberculin skin test.




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