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 journalArticlepeer-review

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)
Pages (from-to)e298
JournalPediatrics
Volume112
Issue number4
DOIs
StatePublished - Oct 2003

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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