Guidelines on the Prevention and Control of Tuberculosis in Ireland

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<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCDetailed instructions on performing a Mantoux test are available on the National Immunisation Officewebsite at www.immunisation.ie/en/Downloads/PDFFile_14983_en.pdf.Similar instructions are also available on the Staten Serum Institut (Denmark) website at www.ssi.dk/sw11710.asp.Recommendation:In all cases, the TST (Mantoux test) should be administered intradermally.StorageCare should be taken to store PPD Mantoux tests and BCG vaccine in separate areas of the fridge toensure the correct product is administered. If using the vial of Tuberculin PPD (Mantoux) on more than onepatient, it is recommended that once the vial is in use, it should be used immediately. Otherwise it shouldnot be in use for longer than 24 hours and stored between 2 and 8°C as per Tuberculin PPD productspecific details from Statens Serum Institut (SSI) in Copenhagen. 32 In light of the need for the immediateuse of the vial of PPD as indicated above, it is recommended that where possible a clinic should bearranged to undertake Mantoux testing on more than one person.Reading the TST (Mantoux test)The TST should be read by a trained health professional. Individuals without experience in reading a TSTmay not feel slight induration and the result may be mistakenly recorded as 0mm.TST interpretation depends on a number of factors as follows:• Measurement of the induration in millimetres• The person’s risk of being infected with TB and of progression to disease if infected• Prior BCG vaccination or exposure to non-tuberculous mycobacteria (NTM) (section 2.4)• Conditions resulting in a false negative result (section 2.4).The results should be read within 48 to 72 hours of receiving the test but a valid reading can usually beobtained up to 96 hours later. The transverse diameter of the area of induration and not the erythemaat the injection site is measured with a ruler and the result recorded using millimetres. As several factorsaffect interpretation of the test, the size of the induration should be recorded and NOT just as a positive ornegative result.It is recommended that the following items are recorded:• Date the induration was read• Measurement of the induration if any in millimetres• Any adverse reactions e.g. blistering (can occur in 3-4% of subjects) and• The name of the individual who read the test.There is some variability in the time at which the test develops its maximum response. The majority oftuberculin-sensitive subjects will be positive at the recommended time of reading. The predictive value canbe enhanced by using cut-off points dependent on the infection risk. The reaction to a TST is classified aspositive based on the individual’s risk factors (see table 2.1). In general, a negative TST result is ≤ 5mm. Forthe interpretation of TST results in contact tracing situations and in screening of HCWs and new entrants,see chapters 8 and 9.-13-
<strong>Guidelines</strong> on the Prevention and Control of Tuberculosis in Ireland 2010HSE/HPSCRecommendation:The TST (Mantoux test) result should be read within 48 to 72 hours of receiving the test. Thetransverse diameter of the area of induration (and not the erythema at the injection site) ismeasured with a ruler and the result recorded using millimetres.Note:• A delay in reading the TST if the result is positive i.e. >5mm does not affect the validity of theresults• A strongly positive TST resulting from inadvertent subcutaneous administration does not affect thevalidity of the reading.Deciding that a TST is positiveThe health professional reading the TST must decide whether the test result is positive. This is based onthe size using the criteria listed in table 2.1. Once a TST is considered positive the individual should bereferred for a medical evaluation. There is no clinical utility in performing a TST in the future once a testthat was properly performed and read is considered positive. 30Medical evaluationThis should include assessment of symptoms suggestive of possible active TB, risk factors for TB such ascontact history or other medical illness and a chest X-ray. In the event of symptoms or an abnormal chestX-ray, sputum for acid-fast bacteria smear and culture should be taken. In persons with no evidence of TBdisease, treatment of LTBI should be considered.-14-
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Guidelines on the Prevention and Control of Tuberculosis in Ireland

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