Tuberculosis in house staff: A decision analysis comparing the tuberculin screening strategy with the BCG vaccination

The BCG vaccination is not recommended for health-care workers in the United States. The current strategy against tuberculosis in tuberculin-negative house staff is an annual tuberculin screening test followed by chemoprophylaxis with isoniazid for a positive result. We performed a decision analysis that unequivocally concluded that the BCG vaccination leads to fewer cases of tuberculosis in this population over a 10-yr period. The BCG vaccine requires only an efficacy rate of at least 13.1% to prevent more cases of tuberculosis than the current strategy. This threshold value is independent of the annual tuberculin conversion rate. This study provides a framework, based on the best information in the literature, on which a well-informed decision regarding tuberculosis prevention can be made. Therefore, this analysis demonstrates that the BCG vaccine should be considered for tuberculin-negative house officers and medical students working in high risk areas of the United States.