BOOSTER PHENOMENON IN SERIAL TUBERCULIN TESTING

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Abstract
To determine the frequency, magnitude and causes of the booster phenomenon in tuberculin testing, 1478 employees from 10 hospitals throughout the USA received sequential intradermal tests using PPD[purified protein derivative]-T. Approximately 70% were initially tested with PPD-G. Boosting was found in all age groups tested, but increased with age. It occurred 1 wk after an initial tuberculin test, but rarely before that time. The boosted reactions were apparently caused by remote tuberculous infection or recent or remote sensitization by 1 or more of the nontuberculous mycobacteria. In areas endemic for nontuberculous mycobacteria, they are the most likely cause of the sensitivity that may be boosted. When repeated tuberculin testing is required as part of a hosptial control program, a 2nd identical tuberculin test should be given 1 wk after the 1st. When subsequent tests are given, this should permit separation of boosted reactions from reactions caused by new infections. Persons who do not boost when given repeat tests at 1 wk, but whose tuberculin reactions change to positive after 1 yr, should be considered to have newly acquired tuberculous infection and managed accordingly.

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