ABSENCE OF THE BOOSTER PHENOMENON IN SERIAL TUBERCULIN SKIN TESTING

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Abstract
The Center for Disease Control recently recommended that tuberculin skin testing of new hospital employees be done in 2 steps because of the so-called booster phenomenon. To assess the feasibility of the 2-step method, from July 1-Dec. 31, 1980, all newly hired employees of the Strong Memorial Hospital [Rochester, New York, USA] were given a 2-step tuberculin skin test as part of their preemployment health evaluation. During this time, 571 new employees were tested, 416 (73%) of whom completed both steps. The mean age of the 416 employees was 26 yr. Fourteen of 448 employees (3.1%) had positive reactions on the 1st test; 0 of the 416 employees had positive reactions on the 2nd test. Additional visits for skin test administration, costs of informational materials, administrative expenses and supplies added significantly to the costs of the tuberculin skin testing program during the study period. The absence of the booster phenomenon in this employee population may be due to the relatively young age of this hospital employee population who may be less likely to have remote infection with Mycobacterium tuberculosis and/or the relatively uncommon occurrence of nontuberculous mycobacterial infection in northeastern USA. Depending on the age of employees of an institution and its geographic location, the 2-step method may not detect any additional reactors. Thus, hospitals contemplating adoption of this method should first perform a similar pilot study to assess the frequency of the booster phenomenon in their employee populations.