[The tuberculin skin test in the Netherlands: new policies for an old test; guideline from the Netherlands Tuberculosis Control Policy Committee]

Abstract

The primary function of tuberculin skintesting is to demonstrate latent tuberculosis infection. The Netherlands Tuberculosis Control Policy Committee revised the guideline for the use and interpretation of the test because of new insights and changes of the epidemiological situation. Tuberculin testing should target persons who are likely to benefit from treatment of latent tuberculosis infection, such as contacts of tuberculosis-source cases, persons with increased occupational risk of tuberculosis exposure and persons with an increased risk of breaking down from infection to active disease as a result of depressed cellular immunity. The contribution of the tuberculin skintest to the diagnosis of active tuberculosis is limited. Different cut-off values for a positive test result are recommended in order to obtain optimum positive and negative predictive values in different target groups. In screening programmes, if the initial test result is 3-9 mm, follow-up tests are only indicated after exclusion of boosting by the initial two-step method. In contact investigations and persons with immune disorders, a history of Bacillus Calmette Guérin (BCG) vaccination should not longer be regarded a contraindication for tuberculin testing.