Tuberculin testing before BCG vaccination

Editor—Our editorial says that the BCG vaccine can be given to young children without prior tuberculin testing. The evidence for this is given in greater detail in the accompanying table. These data show a greater sensitivity (93%) and similar specificity (91%) of the early reaction to BCG in identifying tuberculosis compared to the Mantoux test (51% and 94%, respectively). The rate of complications is low, even in those with tuberculosis. The benefits of a single rather than multistep procedure are self evident.

Table 1.

Data on BCG test in the diagnosis of tuberculosis in children

		Tuberculosis patients						Controls
			BCG test		Mantoux			BCG test		Mantoux		No of patients with complications _ of BCG test (%)
Study	Age group	No	Yes	No	Yes	No	No	Yes	No	Yes	No
Udani et al, 19711	Paediatric	21	15	6	10	11	Not done					None
Kapoor et al, 19822	4 months-10 years	123	111	12	59	64	40	3	37	0	40	1 ulcer 2 regional lympadenitis (1.84%)
Bhanderi et al, 19843 (prospective study)	Paediatric	165	148	17	80	85	700	61	639	24	676	8 regional lymphadenitis (0.6%)
		73	73	0	ND	ND	407	21	386	ND	ND
Velhal et al, 19914	0-12 years	93	93	0	56	37	58	30	28	23	35	None (6/93 Mantoux related ulcers)
Göçmen et al, 19915	0-12 years	31	31	0	10	10	20	0	20	0	20	None
Total		506	471	35	215	207	1225	115	1110	47	771

Not all subjects received a Mantoux test.

The large review of adverse effects did not show that a positive tuberculin skin test increased the likelihood of complications from the BCG vaccine.⁶ Skin tuberculosis at the site of vaccination was rare (254 of 10 371 recorded complications, being rarer since 1968), but was mentioned as the only complication where older age was significant. Although these data imply that those aged 10-14 years (or even adults) do not require a tuberculin skin test before BCG vaccination, we consider an evaluation of a change in policy for those aged 0-10 years a wise first step before recommending any alteration in the current schools programme.