Risk of tuberculosis infection and tuberculous meningitis after discontinuation of Bacillus Calmette-Guerin in Beijing

In Beijing, the notification rate of smear-positive tuberculosis (TB) has b een below 20 per 100,000 since 1986, and continues to decline. To accuratel y measure the risk of TB infection in a population in which the results of tuberculin skin testing were not confounded by vaccination with Bacillus Ca lmette-Guerin (BCG), BCG vaccination at birth was discontinued from 1988 in Shun-yi County. In 1995, the prevalence of TB infection among 12,836 prima ry school children aged 6 to 7 yr and without BCG scars was 1.4%, giving an estimated annual risk of infection of 0.19% (95% confidence interval: 0.16 to 0.22%). The prevalence of TB infection in children aged 5 to 9 yr in Be ijing in 1950 was 46%. The number of cases of tuberculous meningitis did no t increase after discontinuation of BCG. We conclude that discontinuation o f BCG had no detectable harmful effects, and that control of TB in Beijing has markedly reduced the prevalence of TB infection since 1950.