title: The Long-term Effect of Bacille Calmette-Guérin Vaccination on Tuberculin Skin Testing: A 55-Year Follow-Up Study.
abstract: Bacille Calmette-Guérin (BCG) vaccination is known to cause false-positive tuberculin skin test (TST) results from cross-reactions with mycobacterial antigens. However, the duration of BCG vaccination influence on the TST is poorly characterized. The objective of this study was to assess the long-term effect of BCG vaccination on TST reactivity.
  
  
  
  Data on TST reactivity were prospectively collected during 1935 to 1947 as part of a clinical trial among Native Americans/Alaskan Natives and were retrospectively collected thereafter between 1948 and 1998. TST induration of ≥ 10 mm was defined as a positive reaction. Kaplan-Meier analysis and multivariate Cox regression were used to compare the time to TST conversion and reversion between the BCG and placebo groups.
  
  
  
  BCG vaccination after infancy was associated with an increased risk of TST reactivity in the first 15 years after vaccination (adjusted hazard ratio [HR], 2.33). This association remained during the interval 16 to 55 years after vaccination, although the effect was attenuated (adjusted HR, 1.26). Age at vaccination modestly impacted the effect of BCG on TST results in the first 15 years. Positive TST results among the BCG-vaccinated group were more likely to revert to negative results during the first 15 years but not in the latter period.
  
  
  
  This study provides evidence that BCG vaccination after infancy may influence TST results beyond the 10-year period conventionally accepted by the Centers for Disease Control and Prevention (CDC), extending up to 55 years after vaccination. This suggests that BCG vaccination should be taken into account when interpreting TST results regardless of the time elapsed since vaccination.
authors.affiliation: Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: james.mancuso@usamru-k.org.
authors.forename: James D
authors.initials: JD
authors.lastname: Mancuso
authors.affiliation: Department of Medicine, William Beaumont Army Medical Center, El Paso, TX.
authors.forename: Rupal M
authors.initials: RM
authors.lastname: Mody
authors.affiliation: Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Cara H
authors.initials: CH
authors.lastname: Olsen
authors.affiliation: Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.affiliation: Department of International Health, Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.affiliation: Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Aronson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001500:BCG Vaccine / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D014373:Tuberculin / Q000276:immunology; D014374:Tuberculin Test; D014376:Tuberculosis / Q000453:epidemiology* / Q000276:immunology; D014481:United States / Q000453:epidemiology; D014611:Vaccination; D055815:Young Adult
chemical_list: D001500:BCG Vaccine; D014373:Tuberculin
keywords: BCG vaccine/therapeutic use; false positive reactions; latent tuberculosis; tuberculin test; tuberculosis; tuberculosis epidemiology