J Korean Med Sci.  2008 Jun;23(3):402-405. 10.3346/jkms.2008.23.3.402.

Boosted Reaction on Two-Step Tuberculin Skin Test among Military Personnel in South Korea, a Setting with an Intermediate Burden of Tuberculosis and Routine Bacille Calmette-Guerin Vaccination

Affiliations
  • 1Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea.
  • 2The Korean Institute of Tuberculosis, Seoul, Korea.
  • 3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.ccm@amc.seoul.kr

Abstract

This study was performed to estimate the rate of boosted reaction in the two-step tuberculin skin test (TST) and to evaluate the associated factors among military personnel of South Korea, which has an intermediate burden of tuberculosis (TB) and a routine bacille Calmette-Guerin (BCG) vaccination policy. Two-step TST was performed on 264 military personnel who did not have a history of close contact to TB. Subjects with a negative reaction to the first test of <10 mm had a second TST applied 1 week later on the other forearm. A positive result (> or =10 mm) on the initial TST was observed in 126 (48%) of the subjects. A boosted reaction on the second TST developed in 32 (23%) of the 124 subjects with a negative initial TST. In multiple logistic regression analysis, the size of the initial TST reaction was the only factor associated with a boosted reaction on the second TST. The high rate of boosted reaction among healthy adults in South Korea suggests that two-step TST should be performed to assess the baseline TST reactivity in settings with an intermediate burden of TB and routine BCG vaccination policy, especially among subjects with an initial TST reaction that is > or =5 mm.

Keyword

Tuberculin Test; Hypersensitivity; Mycobacterium bovis; Korea

MeSH Terms

Adult
BCG Vaccine/*administration & dosage
Humans
Hypersensitivity/*diagnosis
Incidence
Korea/epidemiology
Logistic Models
Male
Middle Aged
*Military Personnel/statistics & numerical data
Prevalence
*Tuberculin Test
Tuberculosis, Pulmonary/*diagnosis/epidemiology/prevention & control

Reference

1. American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med. 2000. 161:S221–S247.
2. Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis. 2006. 10:1192–1204.
3. Joos TJ, Miller WC, Murdoch DM. Tuberculin reactivity in bacille Calmette-Guerin vaccinated populations: a compilation of international data. Int J Tuberc Lung Dis. 2006. 10:883–891.
4. Menzies D. Interpretation of repeated tuberculin tests. Boosting, conversion, and reversion. Am J Respir Crit Care Med. 1999. 159:15–21.
5. Al Mazrou AM. Booster effect of two-step tuberculin skin testing among hospital employees from areas with a high prevalence of tuberculosis. Infect Control Hosp Epidemiol. 2004. 25:1117–1120.
Article
6. Hizel K, Maral I, Karakus R, Aktas F. The influence of BCG immunisation on tuberculin reactivity and booster effect in adults in a country with a high prevalence of tuberculosis. Clin Microbiol Infect. 2004. 10:980–983.
Article
7. Salles CG, Ruffino-Netto A, Lapa-e-Silva JR, Kritski AL, Cailleaux-Cesar M, Queiroz-Mello FC, Conde MB. The presence of a booster phenomenon among contacts of active pulmonary tuberculosis cases: a retrospective cohort. BMC Public Health. 2007. 7:38.
Article
8. World Health Organization. Global tuberculosis control: surveillance, planning, financing. WHO report 2007. 2007. Geneva, Switzerland:
9. Choi CM, Kang CI, Kim DH, Kim CH, Kim HJ, Lee CH, Yim JJ. The role of TST in the diagnosis of latent tuberculosis infection among military personnel in South Korea. Int J Tuberc Lung Dis. 2006. 10:1342–1346.
10. Cauthen GM, Snider DE Jr, Onorato IM. Boosting of tuberculin sensitivity among Southeast Asian refugees. Am J Respir Crit Care Med. 1994. 149:1597–1600.
Article
11. Frenzel EC, Thomas GA, Hanna HA. The importance of two-step tuberculin skin testing for newly employed healthcare workers. Infect Control Hosp Epidemiol. 2006. 27:512–514.
Article
12. Menzies R, Vissandjee B, Rocher I, St Germain Y. The booster effect in two-step tuberculin testing among young adults in Montreal. Ann Intern Med. 1994. 120:190–198.
Article
13. Moreno S, Blazquez R, Novoa A, Carpena I, Menasalvas A, Ramírez C, Guerrero C. The effect of BCG vaccination on tuberculin reactivity and the booster effect among hospital employees. Arch Intern Med. 2001. 161:1760–1765.
Article
14. Morse DL, Hansen RE, Grabau JC, Cauthen G, Redmond SR, Hyde RW. Tuberculin conversions in Indochinese refugees. An assessment of boosting and anergy. Am Rev Respir Dis. 1985. 132:516–519.
15. Morse DL, Hansen RE, Swalbach WG, Redmond SR, Grabau JC. High rate of tuberculin conversion in Indochinese refugees. JAMA. 1982. 248:2983–2986.
Article
16. Sepulveda RL, Ferrer X, Latrach C, Sorensen RU. The influence of Calmette-Guerin bacillus immunization on the booster effect of tuberculin testing in healthy young adults. Am Rev Respir Dis. 1990. 142:24–28.
17. Sherman RA, Shimoda KJ. Tuberculosis tracking: determining the frequency of the booster effect in patients and staff. Am J Infect Control. 2001. 29:7–12.
Article
18. Srour-Fihmi S, Weiler-Ravell D, Kitzes R, Chemtob D. Routine two-step skin testing for tuberculosis in the staff of a geriatric hospital in Israel: booster and conversion rates. J Hosp Infect. 2000. 46:141–146.
Article
19. Wang PD. Two-step tuberculin testing of passengers and crew on a commercial airplane. Am J Infect Control. 2000. 28:233–238.
Article
20. Sepkowitz KA, Feldman J, Louther J, Rivera P, Villa N, DeHovitz J. Benefit of two-step PPD testing of new employees at a New York City hospital. Am J Infect Control. 1997. 25:283–286.
Article
21. Hong YP, Kim SJ, Lew WJ, Lee EK, Han YC. The seventh nationwide tuberculosis prevalence survey in Korea, 1995. Int J Tuberc Lung Dis. 1998. 2:27–36.
22. Alvarez S, Kasprzyk DR, Freundl M. Two-stage skin testing for tuberculosis in a domiciliary population. Am Rev Respir Dis. 1987. 136:1193–1196.
Article
23. Welty C, Burstin S, Muspratt S, Tager IB. Epidemiology of tuberculous infection in a chronic care population. Am Rev Respir Dis. 1985. 132:133–136.
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