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Tuberculosis
PEDIATRICS Vol. 112 No. 4 October 2003, pp. e298-e298

ELECTRONIC ARTICLE

A Prospective Study of Bacillus Calmette-Guérin Scar Formation and Tuberculin Skin Test Reactivity in Infants in Lima, Peru

Eunice M. Santiago, BSc*, Elise Lawson, BSc*, Kari Gillenwater, BSc*, Sheela Kalangi, BSc*, Andrés G. Lescano, MHS*,{ddagger}, Gregory Du Quella, BSc*, Kristin Cummings, MD*, Lilia Cabrera, RN*, Cecilia Torres* and Robert H. Gilman, MD*,§,||

* Asociación Benéfica Proyectos en Informática, Salud, Medicina y Agricultura, Lima, Peru
{ddagger} Global Emerging Infection System, Naval Medical Research Center Detachment, Lima, Peru
§ Department of International Health, Johns Hopkins University Bloomberg School of Hygiene and Public Health, Baltimore, Maryland
|| Universidad Peruana Cayetano Heredia, School of Public Health and Health Administration and School of Medicine, Department of Pathology, Lima, Peru

Objectives. To determine the sensitivity of the bacillus Calmette-Guérin (BCG) scar as an indicator of previous vaccination and to ascertain the tuberculin skin test (TST) response in infancy after vaccination in a community from an area hyperendemic for tuberculosis (TB).

Methods. In a birth cohort of healthy term infants from Lima, Peru, a single dose of BCG vaccine was administered within the first month of life. Scar formation was assessed biweekly during the first 6 months and again at 3 years after vaccination. TST response was evaluated 6 months after vaccination.

Results. Six months after vaccination, 99% (68) of the newborns exhibited a BCG scar (>2 mm). Scar size did not differ by sex, birth weight, age at vaccination, or nutritional status in the first 2 months. Eighty percent of the participants were found 3 years after vaccination, and all of them had a BCG scar. Mean TST reaction size 6 months after vaccination was 2.9 ± 0.3 mm. No association was found between sex or age at BCG vaccination and TST size. Only 3 children had a TST >10 mm, and the 3 had a TB contact at home.

Conclusions. The BCG scar was a sensitive indicator of vaccination status up to 3 years after the administration of the vaccine in the first month of life. Although nearly a quarter of the children had a TST response >5 mm 6 months after vaccination, TST reactions >10 mm did not occur in the absence of exposure to a person with tuberculosis. A cutoff of 10 mm should be used for disease control purposes in people who are born in countries where TB is endemic.

Key Words: tuberculosis • children • Peru • BCG scar • tuberculin skin test

Abbreviations: TB, tuberculosis • WHO, World Health Organization • BCG, bacillus Calmette-Guérin • TST, tuberculin skin test • CI, confidence interval

Received for publication Jan 3, 2003; Accepted Jun 10, 2003.




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