Effect of neonatal bacille Calmette-Guérin on the tuberculin skin test reaction in the first 2 years of life

Kurtz, T; Feil, Andréia Ivete; Nascimento, Leonardo Silveira; Abreu, Paola de Oliveira; Scottá, Marcelo Comerlato; Pinto, Leonardo Araújo

doi:10.5588/ijtld.18.0201

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…Likewise, two meta-analyses showed that vaccination with BCG significantly increases the likelihood of a positive TST [ 20 , 21 ]. In contrast, a cross-sectional study in Brazil has shown that BCG had a low impact on TST in children <2 years old without apparent contact with TB patients [ 10 ], and a cohort study in India demonstrated that no infant who received BCG vaccination within the first month of life had a TST reaction size greater than 10 mm [ 11 ]. Two studies, however, differ from ours in vaccine strain, administration method, age group tested, environmental mycobacteria, and sample size, thus leading to the challenges of interpretation.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of positive tuberculin skin test in neonates exposed to pulmonary tuberculosis

Choi,

Kim,

Kim

et al. 2024

PLoS ONE

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Background Neonates are at risk of nosocomial tuberculosis (TB) infection from health care workers (HCWs) in neonatal care facilities, which can progress to severe TB diseases. Tuberculin skin test (TST) is commonly used for TB diagnosis, but its accuracy in neonates is influenced by various factors, including bacilli Calmette-Guérin (BCG) vaccination. This study aimed to identify predictors of positive TSTs in neonates exposed to HCWs with pulmonary TB. Methods A retrospective observational study was conducted to compare the frequency of predictors between TST-positive and TST-negative neonates. Demographic, epidemiological, and clinical data of neonates exposed to TB, along with that of HCW and household contacts, were collected retrospectively through contact investigations with the Korean National TB Surveillance System (KNTSS) database. TSTs using 2 tuberculin units of purified protein derivative RT23 were performed on exposed neonates at the end of preventive TB treatment. Firth logistic regression was performed to identify predictors of TST positivity. Results Contact investigations revealed that 152 neonates and 54 HCWs were exposed to infectious TB index cases in 3 neonatal care facilities. Of 152 exposed neonates, 8 (5.3%) had positive TST results. Age of 6 days or more at the initial exposure is a statistically significant predictor of positive TST (Firth coefficient 2.1, 95% confidence interval 0.3–3.9, P = 0.024); BCG vaccination showed no statistical significance in both univariable and multivariable analysis. Sex, prematurity, exposure duration, duration from initial exposure to contact investigation, and isoniazid preventive treatment duration were not significant predictors. Conclusion Age at the initial exposure is a significant predictor of positive TST in neonates exposed to active pulmonary TB. Given the complexities of TST interpretation, including false positives due to BCG vaccination, careful risk assessment is necessary for appropriate decision-making and resource allocation in the management of neonatal TB exposure.

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Section: Discussionmentioning

confidence: 99%

“…One major factor is the bacilli Calmette-Gue ´rin (BCG) vaccination, which reduces the specificity of the TST test and can lead to unnecessary treatment for those without TB Infection [6][7][8][9]. Some studies, however, presented conflicting results, indicating that BCG vaccination has only a limited effect on TST among infants [10,11].…”

Section: Introductionmentioning

confidence: 99%

Predictors of positive tuberculin skin test in neonates exposed to pulmonary tuberculosis

Choi,

Kim,

Kim

et al. 2024

PLoS ONE

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“…In Brazil, immunization (BCG vaccine) is performed at birth, which is mandatory, but it is known to confer only immunity to severe forms of tuberculosis. Thus, all Brazilians are vaccinated, and this influences the TST results since the vaccine is active for ten years after its application (24) . Conversely, this study is composed of adult or young adult patients, being questioned on the first visit the possibility of revaccination, being negative in all cases (TABLE 3) (23,25,26) .…”

Section: Discussionmentioning

confidence: 99%

Rate of Infection (Tuberculosis) in Brazilians Ibd Private Patients: Follow-Up 15 Years

CURY,

MICHELETTI

et al. 2024

Arq. Gastroenterol.

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Background: Latent tuberculosis (LTB) is a condition where the patient is infected with Mycobacterium tuberculosis but does not develop active TB. There’s a possibility of tuberculosis (TB) activation following the introduction of anti-TNFs. Objective: To assess the risk of biological therapy inducing LTB during inflammatory bowel diseases (IBD) treatment over 15 years in a high-risk area in Brazil. Methods: A retrospective study of an IBD patients’ database was carried out in a private reference clinic in Brazil. All patients underwent TST testing and chest X-ray prior to treatment, and once a year after starting it. Patients were classified according to the Montreal stratification and risk factors were considered for developing TB. Results: Among the analyzed factors, age and gender were risk factors for LTB. DC (B2 and P) and UC (E2) patients showed a higher number of LTB cases with statistical significance, what was also observed for adalimumab and infliximab users, compared to other medications, and time of exposure to them favored it significantly. Other factors such as enclosed working environment have been reported as risk. Conclusion: The risk of biological therapy causing LTB is real, so patients with IBD should be continually monitored. This study reveals that the longer the exposure to anti-TNFs, the greater the risk.

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“…TST reactivity among BCG-vaccinated population is affected by multiple factors such as the strain and dose of BCG vaccine, 29 30 the method of vaccination, 31 the number of BCG doses, 32 33 age at vaccination, 34 and the time interval since BCG vaccination. 34 35 36 37 Kurtz et al 37 assessed the effect of neonatal BCG on TST reaction in the first 2 years of life in children without TB exposure. There was a significant decrease in mean TST reaction with an increase in age.…”

Section: Discussionmentioning

confidence: 99%

Contact Investigations With a Single Tuberculin Skin Test on Infants Exposed to Tuberculosis in a Postpartum Care Center During the Neonatal Period

Choi,

Oh,

Lee

et al. 2023

J Korean Med Sci

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Background Tuberculosis (TB) exposure in congregate settings related to neonates is a serious medical and social issue. TB exposure happens during the neonatal period, but contact investigations for exposed infants are usually conducted after the neonatal period. Generally, recommendations for screening and managing close contact are different for neonates and children. Thus, there are challenges in contact investigations. We aimed to report contact investigations with a single tuberculin skin test (TST) on infants exposed to infectious TB in a postpartum care center. Methods The index case was a healthcare worker with active pulmonary TB: sputum acid-fast bacilli smear negative, culture positive, and no cavitary lesion. All exposed infants underwent medical examinations and chest X-ray. After TB disease was ruled out, contacts received window period prophylaxis with isoniazid (INH) until three months after the last exposure. TST was performed only once after completing the prophylaxis. Results A total of 288 infants were selected as high-priority contacts. At the initial contact investigation, the age of infants ranged from 8 to 114 days. None of these exposed infants had TB disease. The prevalence of latent TB infection (LTBI) was 25.3% (73/288; 95% confidence interval [CI], 20.7–30.7). There were no serious adverse events related to the window period prophylaxis or LTBI treatment with INH. During the 1-year follow-up period, no infants progressed to overt TB disease. The size of TST induration in infants vaccinated with percutaneous Bacillus Calmette-Guérin (BCG) vaccine was significantly larger than that of infants vaccinated with intradermal BCG vaccine (median, 8 mm vs. 5 mm; P = 0.002). In multiple logistic regression analysis, independent factors associated with TST positivity (≥ 10 mm induration) were male (adjusted odds ratio [aOR], 2.98; 95% CI, 1.6–5.64), percutaneous BCG vaccination (aOR, 3.30; 95% CI, 1.75–6.48), TST reading between 60 and 72 hours after injecting purified protein derivative (aOR, 2.87; 95% CI, 1.53–5.49), and INH prophylaxis more than four weeks (aOR, 0.49; 95% CI, 0.25–0.94). Conclusion A single TST at three months after the last TB exposure with INH prophylaxis could be used as a main protocol in contact investigations for infants exposed to infectious TB during the neonatal period in congregate settings in Korea.

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Effect of neonatal bacille Calmette-Guérin on the tuberculin skin test reaction in the first 2 years of life

Cited by 4 publications

References 17 publications

Predictors of positive tuberculin skin test in neonates exposed to pulmonary tuberculosis

Predictors of positive tuberculin skin test in neonates exposed to pulmonary tuberculosis

Rate of Infection (Tuberculosis) in Brazilians Ibd Private Patients: Follow-Up 15 Years

Contact Investigations With a Single Tuberculin Skin Test on Infants Exposed to Tuberculosis in a Postpartum Care Center During the Neonatal Period

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