The American Geriatrics Society Statement on Two‐step PPD Testing for Nursing Home Patients on Admission

Pattee, James J.; Burton, John; Frengley, J D; Ryan, Joseph J.; G, Blandford; Finucane, Thomas E.; Irvine, Patrick W.; Stokes, David K.

doi:10.1111/j.1532-5415.1988.tb03438.x

Cited by 19 publications

(5 citation statements)

References 13 publications

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“…Our results confirmed the recommendation by the American Geriatrics Society and others 1 – 3 to perform an initial two‐step tuberculin test for all nursing home patients. Six percent of those patients who were negative on the first skin test became positive on the booster and most of these patients, 70%, were over the age of 70.…”

Section: Relationship Of Age and Results Of Two‐step Tuberculin Skin supporting

confidence: 87%

“…To the Editor :—Following the recommendation of the American Geriatric Society as published in the Journal of the American Geriatrics Society , January, 1988, 1 all patients at Sunny Acres Skilled Nursing Facility received a tuberculin skin test using the two‐step PPD method. Sunny Acres, a 320‐bed skilled nursing facility located in Cleveland, Ohio, is a part of the Cuyahoga County Hospital System which includes a tertiary care hospital, a rehabilitation unit, a nursing home, and outreach ambulatory facilities.…”

Section: Relationship Of Age and Results Of Two‐step Tuberculin Skin mentioning

confidence: 99%

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Two‐Step PPD Testing for Nursing Home Patients

Lefton

1989

J American Geriatrics Society

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Section: Relationship Of Age and Results Of Two‐step Tuberculin Skin supporting

confidence: 87%

Section: Relationship Of Age and Results Of Two‐step Tuberculin Skin mentioning

confidence: 99%

Two‐Step PPD Testing for Nursing Home Patients

Lefton

1989

J American Geriatrics Society

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“…Had we tested a larger number of subjects, we may have seen a true difference between subject populations. In fact, however, a positive booster response to PPD has been reported to occur more commonly in older than younger persons; 34 this may be due to primary sensitization in the case of tuberculin or factors related to time lapse since primary antigenic exposure.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous‐Delayed Hypersensitivity in Nursing Home and Geriatric Clinic Patients

Rodysill¹,

Hansen²,

O’Leary³

1989

J American Geriatrics Society

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Cutaneous-delayed hypersensitivity was studied by one and two-step Mantoux-type skin tests to four standard antigens in 33 elderly nursing home residents, 34 geriatric clinic patients, and 20 healthy young adult controls. Demographic and anthropometric data were collected to determine the effects of nutrition and other variables on cutaneous-delayed hypersensitivity. Anergy (a lack of response greater than 5 mm of induration when read at 48 hours) to any of the four antigens occurred in 34% of nursing home residents, 17% of geriatric clinic patients, and none of the healthy young adults. Mean and maximal responses were less in the nursing home residents than the clinic patients or controls, even if anergic individuals were excluded from analysis, suggesting both a qualitative and quantitative decline in cell-mediated immune function in this elderly population. Repeat testing with each antigen for which there was a negative initial response revealed a "booster" affect of 7 to 19% and occurred as commonly in the healthy young adults as in the nursing home residents or geriatric clinic patients. The mumps antigen elicited strong responses in the healthy young adults, but weak reactions in the nursing home residents. An unexpectedly high prevalence of positive tuberculin (PPD) responses occurred in the nursing home residents, suggesting recent exposure. Analysis of anthropometric and demographic characteristics show that neither nutritional status nor age alone can account for differences in cutaneous-delayed hypersensitivity observed between populations. Cutaneous-delayed hypersensitivity may vary widely between elderly populations and have important practical implications for the tuberculin test.

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“…It can be assumed that the individual who became positive on the second test entered the institution in that condition. The two-step tuberculin test has been widely recommended wherever surveillance is important enough to warrant periodic tuberculin testing (Finucane, 1988;Barry, Regan, & Kunches, 1987;Burstin, Muspratt, & Rossing, 1986;Chaparas, Vandiviere, & Melvin, 1985;Kearns, Cole, & Farer, 1985; "The tuberculin skin test," 1981; Comstock & Woolpert, 1978).…”

Section: Two-stage Tuberculin Testingmentioning

confidence: 99%

Two-Stage Tuberculin Testing in a Prison Population

Brady¹,

Spencer²

2000

Journal of Correctional Health Care

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In the New Mexico Corrections Department, mass screening of male inmates revealed a purified protein derivative of tuberculin (PPD) conversion rate of 3.9 percent and led to the institution of two-stage skin testing of all new inmates. This policy change resulted in a drop of the annual conversion rate to O.9 percent. An analysis of the two-stage testing program showed that of 518 subjects classified as PPD positive, 121 were so classified on the basis of a documented history of a prior positive test, and 397 underwent the two-stage protocol. Of these, 273 (69%) had a significant reaction to the first test. The remaining 124 (31%) required the booster effect of the first test and had significant reactions only to the second test. Two-stage testing is recommended for new inmates of long-term correctional facilities, in order to establish accurate baseline information and to avoid the trap of false converter rates.

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The American Geriatrics Society Statement on Two‐step PPD Testing for Nursing Home Patients on Admission

Cited by 19 publications

References 13 publications

Two‐Step PPD Testing for Nursing Home Patients

Two‐Step PPD Testing for Nursing Home Patients

Cutaneous‐Delayed Hypersensitivity in Nursing Home and Geriatric Clinic Patients

Two-Stage Tuberculin Testing in a Prison Population

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