The Effect of BCG Vaccination on Tuberculin Reactivity and the Booster Effect Among Hospital Employees

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Abstract
ALTHOUGH tuberculosis has long been recognized as an occupational hazard for health care workers,1,2 concern about the risk of acquisition of the infection has increased recently after reports of occupationally acquired tuberculous infection and disease among hospital employees.3-6 This concern led the Centers for Disease Control and Prevention to revise previous recommendations and to publish more stringent and comprehensive guidelines for reducing the risk of transmitting Mycobacterium tuberculosis in the hospital environment.7 Central in the Centers for Disease Control and Prevention recommendations is the monitoring of tuberculous infection of hospital personnel who are likely to be exposed to tuberculous patients, through periodic tuberculin testing. Two-step testing (ie, administration of a second tuberculin test after 1 to 3 weeks when there has not been a significant reaction to a first test) is the procedure recommended in the initial examination of hospital employees, so that a boosted response can be elicited in those with remote tuberculosis infection. The reaction to the boosted (second) test is considered to indicate the infection status of the person tested.

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