TUBERCULOSIS SCREENING IN ADULTS WHO HAVE RECEIVED BACILLE CALMETTE-GUERIN VACCINE

The incidence of tuberculosis among immigrants to the United States is 12 times that in the native-born population. Screening immigrants for tuberculosis is complicated by the widespread use of bacille Calmette -Guerin (BCG) vaccination, To determine the utility of tuberculin test ing in adults who have been vaccinated with BCG vaccine, we studied th e tuberculin reactions of 80 adults who came to us for naturalization physical examinations. No adverse effects were reported from tuberculi n testing, Subjects from regions with a low prevalence of tuberculosis who had received BCG vaccine were significantly more likely to have a positive reaction than subjects who had not received BCG vaccine. How ever, among subjects from regions with a high prevalence of tuberculos is, there was no difference in the prevalence of positive reactions be tween those who reported having BCG vaccinations and those who said th ey had not. Interpretation of tuberculin reactions in immigrants who r eceive BCG vaccinations depends on the prevalence of tuberculosis in t he country of origin, Adults receiving BCG vaccination who have a posi tive reaction and no evidence of active tuberculosis should receive pr ophylactic therapy or be observed carefully.