Bacille Calmette Guérin immunization of health care workers exposed to multidrug-resistant tuberculosis: a decision analysis.

SETTING

North American health care workers with exposure to multidrug-resistant tuberculosis.

OBJECTIVE

To evaluate the relative utilities of bacille Calmette Guérin (BCG) immunization and post-infection chemoprophylaxis for the protection of health care workers exposed to multidrug-resistant Mycobacterium tuberculosis.

DESIGN

Decision analysis using SMLTREE software and published data for probabilities.

RESULTS

BCG vaccination was preferred by a small margin over post-infection chemoprophylaxis. Sensitivity analysis revealed that possible changes in probability values used tended to tilt the result towards use of BCG vaccination. The threshold for protective efficacy of BCG vaccination was 26%.

CONCLUSIONS

BCG vaccination should be considered for health care workers in environments where there is a substantial risk of exposure to multidrug-resistant tuberculosis.