Association of tuberculin sensitivity in Dutch adults with history of travel to areas of with a high incidence of tuberculosis.
International travel may be a source of introduction of tuberculosis into low-incidence countries. We assessed whether, in The Netherlands, sensitivity to tuberculin was associated with a history of travel to countries with a high incidence of tuberculosis. Immunocompetent adults with no history of Bacille Calmette-Guérin vaccination or sensitivity to tuberculin were skin-tested simultaneously with 1-tuberculin unit (TU) purified protein derivative (PPD) of Mycobacterium tuberculosis and 1-TU sensitin of Mycobacterium scrofulaceum. Tuberculin sensitivity was defined as a reaction to PPD of > or =10 mm that was > or =3 mm larger than the reaction to M. scrofulaceum sensitin. Tuberculin sensitivity was found in 7 (0.7%) of 1014 participants (95% confidence interval [CI], 0.3%-1.4%); it was independently associated with a cumulative history of >3-months' travel to high-incidence areas (odds ratio, 6.0; 95% CI, 1.2-31.2; P=.016) and increased in association with total duration of travel (P=.02). Travel to high-incidence areas increases the risk of tuberculin sensitivity and, consequently, of latent tuberculous infection. In countries with a low incidence of tuberculosis, cases of infection acquired during travel may account for a substantial proportion of new infections in the resident population.
Cobelens
F G
FG
Division of Infectious Diseases, Tropical Medicine, and AIDS, Academic Medical Center, 1100 DE Amsterdam, The Netherlands. f.g.cobelens@amc.uva.nl
van Deutekom
H
H
Draayer-Jansen
I W
IW
Schepp-Beelen
A C
AC
van Gerven
P J
PJ
van Kessel
R P
RP
Mensen
M E
ME
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012680:Sensitivity and Specificity; D014195:Travel; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology