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Pseudoepidemics of tuberculin skin test conversions in the U.S. Army after recent deployments.
Am J Respir Crit Care Med. 2008 Jun 01; 177(11):1285-9.AJ

Abstract

RATIONALE

The tuberculin skin test (TST) has many sources of error. These can lead to predominantly false-positive reactions when used in low-risk populations. The U.S. Army deploys to areas considered at high risk for tuberculosis (TB) infection, but often has limited contact with the local population.

OBJECTIVES

We describe the investigation of eight pseudoepidemics of TST conversions in U.S. Army populations, five of which were associated with overseas deployments.

METHODS

Outbreak investigations of these pseudoepidemics consisted of several components: evaluation of active and latent TB surveillance data, review of medical records, investigation and interviews of active TB cases and their contacts, evaluation of materials and personnel screening procedures, and placement and reading of repeat skin testing.

MEASUREMENTS AND MAIN RESULTS

Initially reported risk of conversion in the outbreaks ranged from 1.3 to 15%. Repeat testing of converters (positives) found that 30 to 100% were negative on retesting. Several sources of false-positive results were identified in these pseudoepidemics, including variability in reading and administration, product variability, and cross-reactions to nontuberculous mycobacteria.

CONCLUSIONS

Pseudoepidemics of TST conversions are a common occurrence after U.S. Army deployments and in U.S. Army populations. U.S. Army forces generally have a low risk of TB infection resulting from deployments due to limited exposure to local nationals with active TB, and universal testing in this population has a low positive-predictive value.

Authors+Show Affiliations

Uniformed Services University of the Health Sciences, Department of Preventive Medicine and Biometrics, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. james.mancuso@us.army.milNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18356566

Citation

Mancuso, James D., et al. "Pseudoepidemics of Tuberculin Skin Test Conversions in the U.S. Army After Recent Deployments." American Journal of Respiratory and Critical Care Medicine, vol. 177, no. 11, 2008, pp. 1285-9.
Mancuso JD, Tobler SK, Keep LW. Pseudoepidemics of tuberculin skin test conversions in the U.S. Army after recent deployments. Am J Respir Crit Care Med. 2008;177(11):1285-9.
Mancuso, J. D., Tobler, S. K., & Keep, L. W. (2008). Pseudoepidemics of tuberculin skin test conversions in the U.S. Army after recent deployments. American Journal of Respiratory and Critical Care Medicine, 177(11), 1285-9. https://doi.org/10.1164/rccm.200802-223OC
Mancuso JD, Tobler SK, Keep LW. Pseudoepidemics of Tuberculin Skin Test Conversions in the U.S. Army After Recent Deployments. Am J Respir Crit Care Med. 2008 Jun 1;177(11):1285-9. PubMed PMID: 18356566.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pseudoepidemics of tuberculin skin test conversions in the U.S. Army after recent deployments. AU - Mancuso,James D, AU - Tobler,Steven K, AU - Keep,Lisa W, Y1 - 2008/03/20/ PY - 2008/3/22/pubmed PY - 2008/6/5/medline PY - 2008/3/22/entrez SP - 1285 EP - 9 JF - American journal of respiratory and critical care medicine JO - Am J Respir Crit Care Med VL - 177 IS - 11 N2 - RATIONALE: The tuberculin skin test (TST) has many sources of error. These can lead to predominantly false-positive reactions when used in low-risk populations. The U.S. Army deploys to areas considered at high risk for tuberculosis (TB) infection, but often has limited contact with the local population. OBJECTIVES: We describe the investigation of eight pseudoepidemics of TST conversions in U.S. Army populations, five of which were associated with overseas deployments. METHODS: Outbreak investigations of these pseudoepidemics consisted of several components: evaluation of active and latent TB surveillance data, review of medical records, investigation and interviews of active TB cases and their contacts, evaluation of materials and personnel screening procedures, and placement and reading of repeat skin testing. MEASUREMENTS AND MAIN RESULTS: Initially reported risk of conversion in the outbreaks ranged from 1.3 to 15%. Repeat testing of converters (positives) found that 30 to 100% were negative on retesting. Several sources of false-positive results were identified in these pseudoepidemics, including variability in reading and administration, product variability, and cross-reactions to nontuberculous mycobacteria. CONCLUSIONS: Pseudoepidemics of TST conversions are a common occurrence after U.S. Army deployments and in U.S. Army populations. U.S. Army forces generally have a low risk of TB infection resulting from deployments due to limited exposure to local nationals with active TB, and universal testing in this population has a low positive-predictive value. SN - 1535-4970 UR - https://www.unboundmedicine.com/medline/citation/18356566/full_citation L2 - https://www.atsjournals.org/doi/10.1164/rccm.200802-223OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -