Ew. Hoskyns et al., USE OF THE 1 TUBERCULIN UNIT (TU) MANTOUX TEST IN THE ASSESSMENT OF TUBERCULOUS INFECTION IN CHILDREN FOLLOWING NEONATAL BCG VACCINATION, Thorax, 49(10), 1994, pp. 1006-1009
Background - BCG vaccination alters the response to tuberculin testing
and influences the potential validity of the Heaf test in the diagnos
is of tuberculosis. This study used a purified protein derivative 1 tu
berculin unit (TU) Mantoux test with a cut off of 5 mm induration as a
n indicator of tuberculous infection in high risk children to determin
e whether this would distinguish infection from previous neonatal BCG
vaccination. Methods - Children at high risk of tuberculosis on chest
radiography, Heaf test, or contact history who had been screened in th
e contact tracing clinic and referred for further assessment were incl
uded in the study. After clinical examination, chest radiography, and
Mantoux testing they were assigned to three groups (tuberculous diseas
e, chemoprophylaxis, or no treatment) and followed up for 6-24 months
in the outpatient clinic and subsequently by postal questionnaire. Res
ults - Comparison of the Heaf and Mantoux tests showed a difference in
the results with 82% of cases positive by the Heaf test and 59% posit
ive by the Mantoux test. Using the Mantoux test result in combination
with clinical and radiographic findings 194 children were allocated to
the Methods three groups as follows: primary tuberculosis (5), chemop
rophylaxis (101), no treatment (88). During follow up for a mean (rang
e) time of 46 (11-102) months four additional cases received treatment
for primary tuberculosis, two in the chemoprophylaxis group and two i
n the untreated group. Conclusions - The use of the 1 TU Mantoux test
after neonatal BCG vaccination reduced the number of children receivin
g treatment from 129 to 93 - that is, by 36%. Although the numbers are
small, there was no increase in the later development of tuberculosis
.