Tuberculosis in house staff. A decision analysis comparing the tuberculin screening strategy with the BCG vaccination.
The BCG vaccination is not recommended for health-care workers in the United States. The current strategy against tuberculosis in tuberculin-negative house staff is an annual tuberculin screening test followed by chemoprophylaxis with isoniazid for a positive result. We performed a decision analysis that unequivocally concluded that the BCG vaccination leads to fewer cases of tuberculosis in this population over a 10-yr period. The BCG vaccine requires only an efficacy rate of at least 13.1% to prevent more cases of tuberculosis than the current strategy. This threshold value is independent of the annual tuberculin conversion rate. This study provides a framework, based on the best information in the literature, on which a well-informed decision regarding tuberculosis prevention can be made. Therefore, this analysis demonstrates that the BCG vaccine should be considered for tuberculin-negative house officers and medical students working in high risk areas of the United States.
Greenberg
P D
PD
Department of Community Medicine, Mount Sinai School of Medicine, New York, New York.
Lax
K G
KG
Schechter
C B
CB
D001500:BCG Vaccine; D003661:Decision Support Techniques; D006801:Humans; D007396:Internship and Residency; D007538:Isoniazid / Q000627:therapeutic use; D009784:Occupational Diseases / Q000175:diagnosis / Q000517:prevention & control*; D011336:Probability; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000517:prevention & control*
D001500:BCG Vaccine; D007538:Isoniazid