Greenberg P D, Lax K G, Schechter C B
Department of Community Medicine, Mount Sinai School of Medicine, New York, New York.
Am Rev Respir Dis. 1991 Mar;143(3):490-5. doi: 10.1164/ajrccm/143.3.490.
The BCG vaccination is not recommended for health-care workers in the United States. The current strategy against tuberculosis in tuberculin-negative house staff is an annual tuberculin screening test followed by chemoprophylaxis with isoniazid for a positive result. We performed a decision analysis that unequivocally concluded that the BCG vaccination leads to fewer cases of tuberculosis in this population over a 10-yr period. The BCG vaccine requires only an efficacy rate of at least 13.1% to prevent more cases of tuberculosis than the current strategy. This threshold value is independent of the annual tuberculin conversion rate. This study provides a framework, based on the best information in the literature, on which a well-informed decision regarding tuberculosis prevention can be made. Therefore, this analysis demonstrates that the BCG vaccine should be considered for tuberculin-negative house officers and medical students working in high risk areas of the United States.
美国不建议医护人员接种卡介苗。目前针对结核菌素阴性住院医师的结核病防控策略是每年进行结核菌素筛查试验，结果呈阳性者随后给予异烟肼化学预防。我们进行了一项决策分析，明确得出结论：在10年期间，卡介苗接种可使该人群中的结核病病例减少。卡介苗只需至少13.1%的有效率就能比现行策略预防更多的结核病病例。该阈值与每年的结核菌素转化率无关。本研究基于文献中的最佳信息提供了一个框架，据此可就结核病预防做出明智决策。因此，该分析表明，对于在美国高风险地区工作的结核菌素阴性住院医师和医学生，应考虑接种卡介苗。
