卡介苗高接种率儿童群体中的结核菌素反应性

Tuberculin reactivity in a pediatric population with high BCG vaccination coverage.

作者信息

Lockman S, Tappero J W, Kenyon T A, Rumisha D, Huebner R E, Binkin N J

机构信息

Division of TB Elimination, National Centers for HIV/AIDS, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

出版信息

Int J Tuberc Lung Dis. 1999 Jan;3(1):23-30.

PMID:10094166

Abstract

SETTING

The tuberculin skin test (TST) is often included in diagnostic algorithms for tuberculosis (TB) in children. TST interpretation, however, may be complicated by prior Bacillus Calmette-Guerin (BCG) vaccination. We assessed the prevalence of and risk factors for positive TST reactions in children 3 to 60 months of age in Botswana, a country with high TB rates and BCG coverage of over 90%.

METHODS

A multi-stage cluster survey was conducted in one rural and three urban districts. Data collected included demographic characteristics, nutritional indices, vaccination status, and prior TB exposure. Mantoux TSTs were administered and induration measured at 48-72 hours.

RESULTS

Of 821 children identified, 783 had TSTs placed and read. Of the 759 children with vaccination cards, 755 (99.5%) had received BCG vaccine. Seventy-nine per cent of children had 0 mm induration, 7% had > or =10 mm induration ('positive' TST), and 2% had > or =15 mm. A positive TST was associated with reported contact with any person with active TB (odds ratio [OR] 1.9; 95% confidence interval [CI] 1.02-3.6), or a mother (OR 5.1; 95% CI 2.1-12.4) or aunt (OR 5.3; 95% CI 2.0-14.0) with active TB. TSTs > or =5 mm (but not > or =10 mm) were associated with presence of a BCG scar. Positive reactions were not associated with age, time since BCG vaccination, clinical signs or symptoms of TB, nutritional status, crowding, or recent measles or polio immunization.

CONCLUSION

The TST remains useful in identifying children with tuberculous infection in this setting of high TB prevalence and extensive BCG coverage.

摘要

背景

结核菌素皮肤试验（TST）常被纳入儿童结核病（TB）的诊断流程。然而，既往卡介苗（BCG）接种可能会使TST结果的解读变得复杂。我们评估了博茨瓦纳3至60月龄儿童中TST阳性反应的患病率及其危险因素，该国结核病发病率高且卡介苗接种覆盖率超过90%。

方法

在一个农村地区和三个城市地区开展了一项多阶段整群调查。收集的数据包括人口统计学特征、营养指标、疫苗接种状况以及既往结核接触史。进行了曼托克斯TST检测，并在48 - 72小时测量硬结情况。

结果

在确定的821名儿童中，783名进行了TST检测并读取结果。在759名有疫苗接种卡的儿童中，755名（99.5%）接种了卡介苗。79%的儿童硬结直径为0 mm，7%的儿童硬结直径≥10 mm（“阳性”TST），2%的儿童硬结直径≥15 mm。TST阳性与报告与任何活动性结核患者接触有关（比值比[OR] 1.9；95%置信区间[CI] 1.02 - 3.6），或与患有活动性结核的母亲（OR 5.1；95% CI 2.1 - 12.4）或阿姨（OR 5.3；95% CI 2.0 - 14.0）接触有关。TST结果≥5 mm（但不是≥10 mm）与卡介苗疤痕的存在有关。阳性反应与年龄、卡介苗接种后的时间、结核病的临床体征或症状、营养状况、拥挤程度或近期麻疹或脊髓灰质炎免疫接种无关。