[Problems about tuberculin skin test raised from consultations and countermeasures--influence to the interpretation of tuberculin skin test in case of the stoppage of BCG revaccination abolition and the introduction of induration measurement].
Since people have very limited access to informations on TB, Chiba Anti-TB Association started "Chiba Kekkaku Dial 110", free TB consultation service through telephone, fax and e-mail, since October 1997. We received 1453 consultations during three years by September 2000. The most frequent consultations was about tuberculin skin test (TST) that amounted to 383, 26.4% of the all consultations. We reviewed the consultations on TST to know why consultations on TST are so frequent and what are problems clients want to know. We categorized the consultations according to the professions of clients and three periods of TST, that is, before testing, during testing and reading, and post reading. There were 178 (46.5%) consultations from health professionals, 134 (35.0%) from general citizens and the rest of them were from those unknown job. The health professionals were 94 physicians, 34 public health nurses, 23 school nurses, 19 nurses, 2 medical technicians, 2 radiographers and 4 others. Consultation after tuberculin reading was the most frequent: 93 out of 178 consultations from health professionals and 97 out of 134 from general citizens. Especially, difficulty in the interpretation of the reading result was common reason of the consultations in both health professionals (69/93) and general citizens (89/97). They feel difficulties in TST result because of widely practiced BCG revaccination and booster phenomenon due to the repetition of TST. Furthermore, TST reading results vary very much between readers especially in double redness (erythema), and it sometimes affects the diagnosis of tuberculosis infection. Therefore, if repeated TST and BCG revaccination practices in children are abolished, most of those consultations might be solved. When induration measurement is used in TST according to the international standard, the complexity of the classifications of the result seems to be dissolved. Considering the current practices in Japan, we recommend that the size of TST induration should be measured and recorded as we measure and record erythema. And induration should be referred in interpretation when they diagnose TB infection with TST.
Nishio
Keiko
K
Chiba Anti-Tuberculosis Association, 1-1-20, Miyako-cho, Chuo-ku, Chiba 260-0001, Japan. inf-cent@cata.or.jp
Suzuki
Kiminori
K
Sunami
Yuko
Y
Shimura
Akimitsu
A
Igari
Hidetoshi
H
Nagao
Keiichi
K
D001500:BCG Vaccine; D006801:Humans; D007117:Immunization, Secondary; D007564:Japan / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000517:prevention & control; D014611:Vaccination
D001500:BCG Vaccine