A prospective study of bacillus Calmette-Guérin scar formation and tuberculin skin test reactivity in infants in Lima, Peru.

Eunice M. Santiago, Elise Lawson, Kari Gillenwater, Sheela Kalangi, Andrés G. Lescano, Gregory Du Quella, Kristin Cummings, Lilia Cabrera, Cecilia Torres, Robert H Gilman

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To determine the sensitivity of the bacillus Calmette-Guérin (BCG) scar as an indicator of previous vaccination and to ascertain the tuberculin skin test (TST) response in infancy after vaccination in a community from an area hyperendemic for tuberculosis (TB). METHODS: In a birth cohort of healthy term infants from Lima, Peru, a single dose of BCG vaccine was administered within the first month of life. Scar formation was assessed biweekly during the first 6 months and again at 3 years after vaccination. TST response was evaluated 6 months after vaccination. RESULTS: Six months after vaccination, 99% (68) of the newborns exhibited a BCG scar (>2 mm). Scar size did not differ by sex, birth weight, age at vaccination, or nutritional status in the first 2 months. Eighty percent of the participants were found 3 years after vaccination, and all of them had a BCG scar. Mean TST reaction size 6 months after vaccination was 2.9 +/- 0.3 mm. No association was found between sex or age at BCG vaccination and TST size. Only 3 children had a TST >10 mm, and the 3 had a TB contact at home. CONCLUSIONS: The BCG scar was a sensitive indicator of vaccination status up to 3 years after the administration of the vaccine in the first month of life. Although nearly a quarter of the children had a TST response >5 mm 6 months after vaccination, TST reactions >10 mm did not occur in the absence of exposure to a person with tuberculosis. A cutoff of 10 mm should be used for disease control purposes in people who are born in countries where TB is endemic.

Original languageEnglish (US)
JournalPediatrics
Volume112
Issue number4
StatePublished - Oct 2003
Externally publishedYes

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Tuberculin Test
Peru
Skin Tests
Bacillus
Cicatrix
Vaccination
Prospective Studies
Tuberculosis
BCG Vaccine
Nutritional Status
Birth Weight
Vaccines
Parturition
Newborn Infant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Santiago, E. M., Lawson, E., Gillenwater, K., Kalangi, S., Lescano, A. G., Du Quella, G., ... Gilman, R. H. (2003). A prospective study of bacillus Calmette-Guérin scar formation and tuberculin skin test reactivity in infants in Lima, Peru. Pediatrics, 112(4).

A prospective study of bacillus Calmette-Guérin scar formation and tuberculin skin test reactivity in infants in Lima, Peru. / Santiago, Eunice M.; Lawson, Elise; Gillenwater, Kari; Kalangi, Sheela; Lescano, Andrés G.; Du Quella, Gregory; Cummings, Kristin; Cabrera, Lilia; Torres, Cecilia; Gilman, Robert H.

In: Pediatrics, Vol. 112, No. 4, 10.2003.

Research output: Contribution to journalArticle

Santiago, EM, Lawson, E, Gillenwater, K, Kalangi, S, Lescano, AG, Du Quella, G, Cummings, K, Cabrera, L, Torres, C & Gilman, RH 2003, 'A prospective study of bacillus Calmette-Guérin scar formation and tuberculin skin test reactivity in infants in Lima, Peru.', Pediatrics, vol. 112, no. 4.
Santiago EM, Lawson E, Gillenwater K, Kalangi S, Lescano AG, Du Quella G et al. A prospective study of bacillus Calmette-Guérin scar formation and tuberculin skin test reactivity in infants in Lima, Peru. Pediatrics. 2003 Oct;112(4).
Santiago, Eunice M. ; Lawson, Elise ; Gillenwater, Kari ; Kalangi, Sheela ; Lescano, Andrés G. ; Du Quella, Gregory ; Cummings, Kristin ; Cabrera, Lilia ; Torres, Cecilia ; Gilman, Robert H. / A prospective study of bacillus Calmette-Guérin scar formation and tuberculin skin test reactivity in infants in Lima, Peru. In: Pediatrics. 2003 ; Vol. 112, No. 4.
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AU - Lawson, Elise

AU - Gillenwater, Kari

AU - Kalangi, Sheela

AU - Lescano, Andrés G.

AU - Du Quella, Gregory

AU - Cummings, Kristin

AU - Cabrera, Lilia

AU - Torres, Cecilia

AU - Gilman, Robert H

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N2 - OBJECTIVES: To determine the sensitivity of the bacillus Calmette-Guérin (BCG) scar as an indicator of previous vaccination and to ascertain the tuberculin skin test (TST) response in infancy after vaccination in a community from an area hyperendemic for tuberculosis (TB). METHODS: In a birth cohort of healthy term infants from Lima, Peru, a single dose of BCG vaccine was administered within the first month of life. Scar formation was assessed biweekly during the first 6 months and again at 3 years after vaccination. TST response was evaluated 6 months after vaccination. RESULTS: Six months after vaccination, 99% (68) of the newborns exhibited a BCG scar (>2 mm). Scar size did not differ by sex, birth weight, age at vaccination, or nutritional status in the first 2 months. Eighty percent of the participants were found 3 years after vaccination, and all of them had a BCG scar. Mean TST reaction size 6 months after vaccination was 2.9 +/- 0.3 mm. No association was found between sex or age at BCG vaccination and TST size. Only 3 children had a TST >10 mm, and the 3 had a TB contact at home. CONCLUSIONS: The BCG scar was a sensitive indicator of vaccination status up to 3 years after the administration of the vaccine in the first month of life. Although nearly a quarter of the children had a TST response >5 mm 6 months after vaccination, TST reactions >10 mm did not occur in the absence of exposure to a person with tuberculosis. A cutoff of 10 mm should be used for disease control purposes in people who are born in countries where TB is endemic.

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