Tuesday, December 20, 2022

Why does BCG vaccine cause false-positive TB test?


Testing in BCG-Vaccinated Persons

Many people born outside of the United States have been given a vaccine called BCG.

People who were previously vaccinated with BCG may receive a TB skin test to test for TB infection. Vaccination with BCG may cause a false positive reaction to a TB skin test

A positive reaction to a TB skin test may be due to the BCG vaccine itself or due to infection with TB bacteria.

TB blood tests (IGRAs), unlike the TB skin test, are not affected by prior BCG vaccination and are not expected to give a false-positive result in people who have received BCG. 


The bacteria are still in your body, but they are not causing damage. However, latent TB bacteria can 'wake up' and become active in the future, making you ill. This can happen many years after you first breathe in TB bacteria.



TB bacteria become active if the immune system can't stop them from growing. When TB bacteria are active (multiplying in your body), this is called TB disease. People with TB disease are sick. They may also be able to spread the bacteria to people they spend time with every day.

TB blood tests are the preferred method of TB testing for people who have received the BCG vaccine. 

Why does BCG vaccine cause false-positive TB test?

Background: Bacille Calmette-Guérin (BCG) vaccination is known to cause false-positive tuberculin skin test (TST) results from cross-reactions with mycobacterial antigens. However, the duration of BCG vaccination influence on the TST is poorly characterized.

Information from the baseline individual TB risk assessment  should be used to interpret the results of a TB blood test or TB skin test given upon hire (i.e., preplacement). Health care personnel with a positive TB test result should receive a symptom evaluation and a chest x-ray to rule out TB disease. Additional workup may be needed based on those results.

Health care personnel with a documented history of a prior positive TB test should receive a baseline individual TB risk assessment and TB symptom screen upon hire (i.e., preplacement). 

A repeat TB test (e.g., TB blood test or a TB skin test) is not required.

Annual TB testing of health care personnel is not recommended unless there is a known exposure or ongoing transmission at a healthcare facility.

Health care personnel with untreated latent TB infection should receive an annual TB symptom screen. Symptoms for TB disease include any of the following: a cough lasting longer than three weeks, unexplained weight loss, night sweats or a fever, and loss of appetite.

We agree that policies governing screening for latent tuberculosis infection in low-risk populations need to be reexamined and changed. The central finding of our longitudinal study is that false-positive QuantiFERON-TB results predominantly occurred in different individuals in each of the 7 years of the study (1).

If you were vaccinated with BCG, you may test “positive” on a TB skin test. 
This may be due to BCG vaccine, OR to a real TB infection. 
The TB skin test cannot tell the difference. 
A positive skin test, even in a person who has been vaccinated with BCG, usually means latent TB infection.
Treatment of latent TB infection is essential to controlling TB in the United States because it substantially reduces the risk that latent TB infection will progress to TB disease.
Yes you can! The BCG vaccine, or Bacille Calmette Guerin, is routinely given in many countries to protect against TB disease. 
Although there is a chance the BCG vaccine may cause a false-positive TB skin test, this is not likely if you received the vaccine more than 10 years ago.A

Our BCG Scar Check Service involves a nurse taking a vaccination history and physically checking the arm for a scar to see whether that person has received the BCG vaccination.

The BCG vaccine can take 3 months to provide protection against TB disease. BCG vaccine should ideally be given 3 months prior to travel to a high TB incidence country. The vaccine loses its effectiveness over time, usually within 5 to 15 years.
Because BCG is a live vaccine, there are some important safety measures to keep in mind that your doctor can explain. BCG can remain in urine for 6 hours after your treatment, so each time you urinate, you should bleach the toilet in your home to neutralize the vaccine.

TB bacteria become active if the immune system can't stop them from growing. When TB bacteria are active (multiplying in your body), this is called TB disease. People with TB disease are sick. They may also be able to spread the bacteria to people they spend time with every day.

Treatment options recommended for LTBI include: 6-month daily isoniazid, or 9 month daily isoniazid, or 3 month weekly rifapentine plus isoniazid, or 3–4 month daily isoniazid plus rifampicin, or 3–4 month daily rifampicin alone. (Strong recommendation, moderate to high quality of evidence.)

Respiratory Syncytial Virus Infection (RSV)

 Respiratory Syncytial Virus Infection (RSV)

reference and copy from : https://www.cdc.gov/rsv/about/symptoms.html

Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. 

RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States.


Symptoms

Doctor examining infant with stethoscope

People infected with RSV usually show symptoms within 4 to 6 days after getting infected. Symptoms of RSV infection usually include

  • Runny nose
  • Decrease in appetite
  • Coughing
  • Sneezing
  • Fever
  • Wheezing

These symptoms usually appear in stages and not all at once. In very young infants with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties.

Almost all children will have had an RSV infection by their second birthday.

However, repeat infections may occur throughout life, and people of any age can be infected. Infections in healthy children and adults are generally less severe than among infants and older adults with certain medical conditions. People at highest risk for severe disease include

  • Premature infants
  • Young children with congenital (from birth) heart or chronic lung disease
  • Young children with compromised (weakened) immune systems due to a medical condition or medical treatment
  • Children with neuromuscular disorders
  • Adults with compromised immune systems
  • Older adults, especially those with underlying heart or lung disease

In the United States and other areas with similar climates, RSV circulation generally starts during fall and peaks in the winter. The timing and severity of RSV circulation in a given community can vary from year to year.

People infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. 

Call your healthcare professional if you or your child is having difficulty breathing, not drinking enough fluids, or experiencing worsening symptoms.


RSV can cause more serious health problems

RSV can also cause more severe infections such as bronchiolitis, an inflammation of the small airways in the lung, and pneumonia, an infection of the lungs. It is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age.

Healthy adults and infants infected with RSV do not usually need to be hospitalized. But some people with RSV infection, especially older adults and infants younger than 6 months of age, may need to be hospitalized if they are having trouble breathing or are dehydrated. 

In the most severe cases, a person may require additional oxygen, or IV fluids (if they can’t eat or drink enough), or intubation (have a breathing tube inserted through the mouth and down to the airway) with mechanical ventilation (a machine to help a person breathe). In most of these cases, hospitalization only lasts a few days.

Learn more about people at high risk for severe RSV infection.

Prevention

Ways to help stop RSV from spreading 

RSV Prevention

There are steps you can take to help prevent the spread of RSV. Specifically, if you have cold-like symptoms you should

  • Cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands
  • Wash your hands often with soap and water for at least 20 seconds
  • Avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others
  • Clean frequently touched surfaces such as doorknobs and mobile devices