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April 28, 1993

Children From Romania: Testing for Tuberculosis-Reply

Author Affiliations

University of Minnesota Minneapolis
Tufts University Boston, Mass

JAMA. 1993;269(16):2085. doi:10.1001/jama.1993.03500160050020

In Reply.  —Dr Jameson's letter highlights some of the controversial issues in the diagnosis and management of tuberculin reactors, especially when testing is performed after BCG vaccination. Among the patients in our study, 41 of 65 Romanian children had been vaccinated with BCG prior to their arrival in the United States. Of the 20 vaccinated children who did not receive tuberculin testing as a part of their initial medical evaluation, two had no induration on subsequent testing by their private physicians, two refused tuberculin testing, one had received BCG vaccine 10 months prior to the clinic visit, and 15 had received BCG vaccine within the antecedent 2 to 3 months and exhibited moist, unhealed BCG vaccination sites. The pediatric literature provides ample precedent that tuberculin testing within 6 months of BCG vaccination elicits induration of at least 5 mm in 60% of children and greater than 10 mm in 30%1;