Bacille Calmette Guérin immunization of health care workers exposed to multidrug-resistant tuberculosis: a decision analysis.
METHODS
North American health care workers with exposure to multidrug-resistant tuberculosis.


OBJECTIVE
To evaluate the relative utilities of bacille Calmette Guérin (BCG) immunization and post-infection chemoprophylaxis for the protection of health care workers exposed to multidrug-resistant Mycobacterium tuberculosis.


METHODS
Decision analysis using SMLTREE software and published data for probabilities.


RESULTS
BCG vaccination was preferred by a small margin over post-infection chemoprophylaxis. Sensitivity analysis revealed that possible changes in probability values used tended to tilt the result towards use of BCG vaccination. The threshold for protective efficacy of BCG vaccination was 26%.


CONCLUSIONS
BCG vaccination should be considered for health care workers in environments where there is a substantial risk of exposure to multidrug-resistant tuberculosis.
Stevens
J P
JP
Center for International Health, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
Daniel
T M
TM
D000995:Antitubercular Agents / Q000627:therapeutic use; D001500:BCG Vaccine; D002939:Ciprofloxacin / Q000627:therapeutic use; D003661:Decision Support Techniques; D006282:Health Personnel; D006801:Humans; D011336:Probability; D011718:Pyrazinamide / Q000627:therapeutic use; D012984:Software; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000517:prevention & control*; D014611:Vaccination
D000995:Antitubercular Agents; D001500:BCG Vaccine; D011718:Pyrazinamide; D002939:Ciprofloxacin