BCG vaccination to prevent tuberculosis in health care workers: a decision analysis.

  • Marcus A
  • Rose D
  • Sacks H
 et al. 
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Abstract

To perform a decision analysis to determine the optimal strategy to
prevent tuberculosis (TB) in health care workers with negative tuberculin
skin tests.We used a Markov model to study the occurrence of events
each year and compared BCG vaccination to annual tuberculin testing
plus isoniazid (INH) preventive therapy for those who become skin
test positive. The outcome measures studied were the number of cases
and deaths from TB and BCG and/or INH adverse reactions over 10 years.Annual
tuberculin testing decreases the number of TB cases by 9% and BCG
vaccination decreases the number by 49%, relative to no prevention
intervention. BCG vaccination results in fewer deaths than annual
tuberculin testing if the workplace incidence of Mycobacterium tuberculosis
infection is greater than 0.06%, BCG vaccination effectiveness exceeds
3%, or the rate of fatal BCG adverse reactions is less than 15 times
the rate reported in the literature.BCG vaccination results in less
morbidity and mortality than annual tuberculin skin testing for health
care workers in workplaces with documented TB transmission despite
comprehensive infection control policies and procedures. Current
policy on the prevention of TB among health care workers should be
reconsidered.

Author-supplied keywords

  • Antitubercular Agents
  • BCG Vaccine
  • Cross Infection
  • Decision Support Techniqu
  • Humans
  • Incidence
  • Markov Chains
  • Models
  • Occupational Exposure
  • Statistical
  • Tu
  • adverse effects
  • adverse effects/statistics /&/ numerical data
  • prevention /&/ control
  • prevention /&/ control/statistics /&/ numerical d
  • statistics /&/ numerical data
  • therapeutic use

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Authors

  • A M Marcus

  • D N Rose

  • H S Sacks

  • C B Schechter

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