title: Tuberculin response in BCG vaccinated schoolchildren and the estimation of annual risk of infection in Hong Kong.
abstract: BACKGROUND
  In Hong Kong there has been nearly universal neonatal BCG vaccination coverage since 1980.
  
  
  METHODS
  21 113 schoolchildren aged 6-9 years were skin tested with one unit of tuberculin (PPD RT-23) using the intradermal technique during a routine BCG revaccination programme. Information on sex, date of birth, date of tuberculin testing, and tuberculin reaction size at 72 hours was retrieved. The annual risk of tuberculous infection (ARTI) was estimated by three different approaches.
  
  
  RESULTS
  Significantly higher tuberculin positive rates were found in girls and with increasing age at all commonly used cut-off points (5, 10, and 15 mm). Using a cut-off point of > or =10 mm and the formula 1- (1 - tuberculin positive rate)(1/age), the ARTI was estimated to be 1.93% (95% CI 1.84 to 2.03) for girls and 1.41% (95% CI 1.33 to 1.50) for boys. Using the differences in the tuberculin positive rate between the 6-7 year and 8-9 year age groups, the ARTI became 1.90% (95% CI 1.09 to 2.70) and 1.84% (95% CI 1.15 to 2.54) for girls and boys, respectively. When the prevalence of infection was estimated by locating a secondary peak of the tuberculin reaction distribution curve at 15 mm and assuming a symmetrical distribution of reaction sizes among those infected around this peak, the corresponding ARTI was much lower at 0.52% (95% CI 0.46 to 0.59) and 0.43% (95% CI 0.37 to 0.49) for girls and boys, similar to that estimated indirectly from the prevalence of disease.
  
  
  CONCLUSIONS
  The ARTI as estimated by conventional methods was unexpectedly high among BCG vaccinated children and did not agree with that anticipated from the annual incidence of active disease. Further studies are needed to address the discrepancies, including the possible interaction between BCG and other environmental stimuli.
authors.affiliation: Tuberculosis Service and Chest Service, Department of Health, Hong Kong, China. cc_leung@dh.gov.hk
authors.forename: C C
authors.initials: CC
authors.lastname: Leung
authors.forename: W W
authors.initials: WW
authors.lastname: Yew
authors.forename: C M
authors.initials: CM
authors.lastname: Tam
authors.forename: C K
authors.initials: CK
authors.lastname: Chan
authors.forename: K C
authors.initials: KC
authors.lastname: Chang
authors.forename: W S
authors.initials: WS
authors.lastname: Law
authors.forename: S N
authors.initials: SN
authors.lastname: Lee
authors.forename: M Y
authors.initials: MY
authors.lastname: Wong
authors.forename: K F
authors.initials: KF
authors.lastname: Au
mesh_terms: D000367:Age Factors; D001500:BCG Vaccine; D002648:Child; D015331:Cohort Studies; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012867:Skin / Q000276:immunology*; D013997:Time Factors; D014373:Tuberculin / Q000276:immunology*; D014374:Tuberculin Test / Q000379:methods; D014376:Tuberculosis / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control
chemical_list: D001500:BCG Vaccine; D014373:Tuberculin