To the Editor.
—In their model of various tuberculosis (TB) control modalities, Dr Brewer and colleagues1 suggest that a targeted vaccination strategy using BCG vaccine would be cost effective for TB prevention. The authors state, "In our simulations, eliminating the ability to screen with tuberculin testing among vaccine recipients did not significantly alter BCG's predicted effectiveness,"1 but they do not comment on what many feel is the most important deterrent to the systematic use of BCG—the loss of surveillance for TB infection in BCG-vaccinated health care workers.To dramatize the significance of this loss of information, we created a scenario2 that indicated the effect widespread systematic use of BCG had in precluding surveillance. The bottom line is that if BCG had been used widely during the last decade, we would not yet know in 1997 that an epidemic of active, multidrug-resistant pulmonary TB with transmission to health care
Reichman LB, Mangura BT. Modalities for Tuberculosis Control: Surveillance vs Vaccination. JAMA. 1997;277(13):1035-1036. doi:10.1001/jama.1997.03540370025022