Teixeira E G, Kritski A, Ruffino-Netto A, Steffen R, Lapa E Silva J R, Belo M, Luiz R R, Menzies D, Trajman A
Gama Filho University, Rio de Janeiro, Rio de Janeiro, Brazil.
Int J Tuberc Lung Dis. 2008 Dec;12(12):1407-13.
Five medical schools in three cities in Rio de Janeiro State, Brazil, with different tuberculosis (TB) incidence rates.
To evaluate the prevalence of the booster phenomenon and its associated factors in a young universally BCG-vaccinated TB-exposed population.
A two-step tuberculin skin test (TST) was performed among undergraduate medical students. Boosting was defined as an induration > or =10 mm in the second TST (TST2), with an increase of at least 6 mm over the first TST (TST1). The association of boosting with independent variables was evaluated using multivariate analysis.
Of the 764 participants (mean age 21.9 +/- 2.7 years), 672 (87.9%) had a BCG scar. The overall booster phenomenon prevalence was 8.4% (95%CI 6.5-10.6). Boosting was associated with TST1 reactions of 1-9 mm (aOR 2.5, 95%CI 1.04-5.9) and with BCG vaccination, mostly after infancy, i.e., after age two years (aOR 9.1, 95%CI 1.2-70.7).
The prevalence of the booster phenomenon was high. A two-step TST in young BCG-vaccinated populations, especially in those with TST1 reactions of 1-9 mm, can avoid misdiagnosis as a false conversion and potentially reduce unnecessary treatment for latent TB infection.
巴西里约热内卢州三个城市的五所医学院，其结核病（TB）发病率各不相同。
评估在普遍接种卡介苗（BCG）的年轻TB暴露人群中增强反应现象的患病率及其相关因素。
对本科医学生进行两步结核菌素皮肤试验（TST）。增强反应定义为第二次TST（TST2）硬结≥10 mm，且比第一次TST（TST1）至少增加6 mm。使用多变量分析评估增强反应与自变量之间的关联。
764名参与者（平均年龄21.9±2.7岁）中，672人（87.9%）有卡介苗疤痕。增强反应现象的总体患病率为8.4%（95%CI 6.5-10.6）。增强反应与TST1反应为1-9 mm有关（调整后比值比[aOR] 2.5，95%CI 1.04-5.9），且与卡介苗接种有关，主要是在婴儿期之后，即两岁之后（aOR 9.1，95%CI 1.2-70.7）。
增强反应现象的患病率较高。在接种卡介苗的年轻人群中进行两步TST，尤其是在TST1反应为1-9 mm的人群中，可以避免误诊为假阳转，并有可能减少潜伏性结核感染的不必要治疗。
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