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Tuberculin skin testing of hospital employees: Infection, “boosting,” and two-stop testing

  • Dixie E. Snider Jr.
    Correspondence
    Reprint requests: Technical Information Services, Center for Prevention Services, Centers for Disease Control, Atlanta, GA 30333.
    Affiliations
    From the Research and Development Branch, Division of Tuberculosis Control, Center for Prevention Services, Centers for Disease Control, Atlanta, Georgia, USA
    Search for articles by this author
  • George M. Cauthen
    Correspondence
    Reprint requests: Technical Information Services, Center for Prevention Services, Centers for Disease Control, Atlanta, GA 30333.
    Affiliations
    From the Research and Development Branch, Division of Tuberculosis Control, Center for Prevention Services, Centers for Disease Control, Atlanta, Georgia, USA
    Search for articles by this author
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      Abstract

      The prevalence of tuberculous infection (i.e., reactions ⩾10 mm to 5 tuberculin units of purified protein derivative; Mantoux skin test) was determined among employees of 10 hospitals located throughout the United States. The risk of infection was strongly associated with age and race/ethnicity; nonwhites and older individuals were at higher risk. The prevalence of infection among hospitals varied threefold, from 7.0% to 21.4%. After adjusting for differences in the characteristics of employee groups (e.g., age, race/ethnicity, and sex), twofold differences among hospitals were still observed. The occurrence of “boosting” on retest was also studied. Among the different hospitals, the rate varied from 0% to nearly 10%. Race/ethnicity and age were the characteristics most closely associated with boosting. From our data and other data in the literature, we conclude that all hospitals should use two-step testing at least on a pilot basis. Our calculations suggest that two-step testing for employees over 35 years of age could be cost effective if the booster rate is greater than 1% of the employees retested.
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