BCG vaccine and Mantoux test

There's a recent TB thread which is prompting me to ask the following question (but figured I'd create a separate thread to keep things neater.)

What are your thoughts regarding the BCG vaccine in childhood causing false-positive results with the 2 step Mantoux test in adulthood?

I've heard various explanations and not sure which camp to believe.
I didn't think there is anything controversial about it. If you received the BCG vaccine as a child, as many people, particularly those born in countries where TB is or was more prevalent did, you will likely test positive for exposure to the TB bacterium (done by TB skin or serum tests) , because you were essentially exposed (through the bacteria used to create the vaccine). TB skin test or blood tests for that matter only show exposure and DO NOT necessarily indicate that you have the latent infection or disease. That is why a follow up chest x-ray or other tests are done to ensure that you are not actually infected, but merely had some level of exposure.My husband was born abroad and receive the BCG vaccine and has always tested positive. He has never had TB or any symptoms...It's no big deal he just gets his chest x-ray.Is there something else you're talking about that I am not understanding? The connection (between BCG and positive TBs) is very well documented. check out the CDC's website for more info: http://www.cdc.gov/tb/topic/testing/default.htm

I started a thread about this quite a while ago outlining the multiple issues I've had after getting BCG as a child and the many positive PPD tests I've had since.The update is that since then there is a test called the Quantiferon TB Gold that distinguishes whether a person has immune response to TB vs. BCG. The PPD skin test reacts either way. My employer wanted me to be treated for TB which of course I resisted. I suggested the Quantiferon TB Gold test but apparently that was too expensive (and at the time only available from the CDC). We decided they would just continue with annual screening which consisted of a questionnaire and leave it at that.The thread I started: Positive PPD with history of BCG - Nursing for NursesLink to Wikipedia entry on Quantiferon TB Gold: QuantiFERON - Wikipedia, the free encyclopedia

I have read many PPDs of people (including children) who received BCG at some point. Probably only about half those PPDs popped up positive. (I used to work at a clinic that did immigration physicals, and a PPD is a standard part.)Is there a connection? If the CDC says so, then I'm inclined to believe there's a connection, though not necessarily a strong one. It's not a guarantee that just because someone receives the BCG they will always have a +PPD. And most of the rest of what I was going to say, the CDC link already says.

Well, I always test positive on the PPD, as do all my friends and family who received the BCG.

Quote from TiffyRNI started a thread about this quite a while ago outlining the multiple issues I've had after getting BCG as a child and the many positive PPD tests I've had since.The update is that since then there is a test called the Quantiferon TB Gold that distinguishes whether a person has immune response to TB vs. BCG. The PPD skin test reacts either way. My employer wanted me to be treated for TB which of course I resisted. I suggested the Quantiferon TB Gold test but apparently that was too expensive (and at the time only available from the CDC). We decided they would just continue with annual screening which consisted of a questionnaire and leave it at that.The thread I started: Positive PPD with history of BCG - Nursing for NursesLink to Wikipedia entry on Quantiferon TB Gold: QuantiFERON - Wikipedia, the free encyclopedia

FYI, if you have had the BCG (as I have) and have a positive PPD test, you have the right to refuse further PPD tests. This is (as I understand it) because the more PPD testS you have, the worse your reaction can get. You just fill in the questionnaire and have the chest xray (most hospitals require one every 5 yrs, some every yr). Some managers don't quite understand this, but the Employee Health people are fine with it.

Thanks to everyone for their helpful responses.I'm not familiar with the Quantiferon test and suspect it isn't available in my area otherwise I likely would have heard of it. It sounds like it would solve many of the problems those of us who test postive on the PPD have to contend with.My experience is that irregardless of what the CDC says many practitioners have strong feelings about whether it's BCG related or not, everything from "yes, it is most likely the cause of positive skin tests" to "no, absolutely not, the BCG vaccine was given too long ago to have an effect now so you must have been exposed." Where? I am not at high risk of exposure. You would be surprised at the conflicting beliefs. I also had public health nurses who supported the probable correlations and others who opposed it vehemently. I am one of those people who have no official record of having received the BCG except for a distant memory and unfortunately the parents are no help, so it is presumed I did, but not confirmed. This admittance bothers some professionals. I do always test postive with the skin induration which, at times, creates a havoc with whomever is doing the testing/reading in not accepting that it is likely BCG related and for the most part pushing for the prophylactic treatment. No thanks! I am not one to recklessly take Acet for a headache unless really bad let alone to take prophylactic anything! Er, except maybe rubbers, but that's beside the point. Many employers and their OH departments don't understand it as well as they should either, which is unfortunate. I still get asked to receive the regular two-step Mantoux DESPITE the fact that my current GP has said there is no point in continuing this waste of time and money, and just go ahead with the CXR, but I still get "harrassed" on occasion depending on who it is. Seriously, this has been a thorn in my side especially since embarking on my professional life in the health care field.

If the health department and your employer are not willing to provide the Quantiferon test, see if your PCP could order it. The cost was prohibitive 6 years ago when I first found out about it, but as its become more common, the price has come down, and some insurances are covering it.

Where I work, the Quantiferon Gold test is the only test used for TB screening. It does require a lab draw and only specially trained lab personnel are allowed to do the draw ( we're not allowed to do it in ICU ). Here's some info:http://www.ctca.org/guidelines/CTCA_..._Statement.pdf

Quote from Belle EpoqueThere's a recent TB thread which is prompting me to ask the following question (but figured I'd create a separate thread to keep things neater.)What are your thoughts regarding the BCG vaccine in childhood causing false-positive results with the 2 step Mantoux test in adulthood?I've heard various explanations and not sure which camp to believe.