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Original Research |

The Long-Term Effect of Bacille Calmette-Guérin Vaccination on Tuberculin Skin Testing: A 55-Year Follow-Up Study

James D. Mancuso, M.D., Dr.P.H.; Rupal M. Mody, M.D.; Cara H. Olsen, Dr.P.H.; Lee H. Harrison, M.D.; Mathuram Santosham, M.D.; Naomi E. Aronson, M.D.
Author and Funding Information

Author contributions: The individuals named above have each provided substantial contributions to the conception and design of this work and each has participated in drafting and revising the manuscript. All have given final approval of the version to be published and agree to be accountable for all aspects of the work.

Sources of funding support: None

Financial disclosures/Conflicts of Interest: None of the authors report a conflict of interest or have financial interests to disclose.

Descriptor Number: 11.4 Mycobacterial Disease: Host Defenses

Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy of the Uniformed Services University of the Health Sciences, Department of Army, the Department of Defense, or the U.S. Government.

1Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD

2William Beaumont Army Medical Center, El Paso, TX

3Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA

4Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

5Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD

Correspondence and reprints to: James D. Mancuso Department of Preventive Medicine and Biostatistics Uniformed Services University of the Health Sciences 4301 Jones Bridge Road Bethesda, MD 20814.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.01.001
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Abstract

Background  Bacille Calmette-Guérin vaccination (BCG) is known to cause false positive tuberculin skin test (TST) results from cross-reactions to mycobacterial antigens. However, the duration of BCG influence on the TST is poorly characterized. The objective of the study was to assess the long-term effect of BCG vaccination on TST reactivity.

Methods  Data on TST reactivity were prospectively collected during 1935-47 as part of a clinical trial among American Indians / Alaskan Natives and retrospectively thereafter between 1948 and 1998. TST induration of > 10 millimeters was defined as positive. Kaplan-Meier and multivariate Cox regression were used to compare the time to TST conversion and reversion between the BCG and placebo groups.

Results  BCG vaccination after infancy was associated with an increased risk of TST reactivity in the first 15 years after vaccination (adjusted Hazard Ratio=2.33). This association remained during the interval 16-55 years after vaccination, although the effect was attenuated (adjusted Hazard Ratio=1.26). Age at vaccination modestly impacted the effect of BCG on TST in the first 15 years. Positive TSTs among the BCG-vaccinated group were more likely to revert to negative during the first 15 years but not in the latter period.

Conclusions  This study provides evidence that BCG vaccination after infancy may influence the TST beyond the 10-year period conventionally accepted by the Centers for Disease Control and Prevention (CDC), extending up to 55 years after vaccination. This suggests that BCG vaccination should be taken into account when interpreting TST results regardless of time elapsed since vaccination.


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