Positive ppd, 2 bcg vaccines

[petra1685]

I was born and raised in Hungary, and had received a BCG vaccine both as an infant, and at age 12. I have lived in the US for the past 10 years, and recently my employer had me take a TB skin test, which had turned out positive. The clinic informed me that the cause of the positive result was probably the BCG vaccines, nonetheless they had referred me to the local Health Department to have a chest x-ray done. The health department said that they will need to repeat the skin test for their own records. (They do not accept outside records of the skin tests) I have also been informed that if I had a positive reaction, it could be dangerous to repeat the skin test because of a severe reaction, especially after multiple BCG vaccines. I am concerned that my overall health an well being is jeopardized unnecessarily, meanwhile my employment is suspended until a chest x-ray confirms or denies TB. I am fairly sure, my positive reaction is tied to the BCG shots. I've been told, the vaccine is not recognized in the US, and risks or not, I have to proceed with the second skin test before I can get a chest x-ray. What exactly are the risks, are there any alternate testing methods, and is it necessary to suspend my employment with such a probability of a false positive reaction in the first place?

[National Jewish Health]

If you came from an area in Hungary in which tuberculosis (TB) was endemic, the positive skin test equally likely to be on the basis of administered Bacille Calmette-Guerin (BCG) vaccine, as on the basis of a prior TB infection, be it currently active or inactive infection.  Maybe even more likely to be the latter, since the propensity to have a positive skin test in response to BCG, diminishes progressively over time and, in many BCG injected people, will revert to negative after 10 or more years have passed.  It is reasonable for your employer to suspend your employment until the issue of TB infection is resolved.  Bottom line is that you should not assume that the positive skin test was caused by the BCG.

If the skin test was weakly positive, it is unlikely that a repeat tuberculin skin test (TST) would cause a serious reaction, assuming that intermediate strength tuberculin was used.  Another option is a serological test for TB called the QuantiFERON-gold in-tube test or The QFT-GIT.  Some experts believe that the QFT-GIT shows the potential to replace the TST for latent TB infection (LTBI) screening in refugees from tuberculosis-endemic areas.

You definitely should have a chest x-ray, taking whatever actions are required to get one.  If raising any sputum, it should be sent to the public health lab for staining and culture.

Good luck.