730. Should We Replace Tuberculin Skin Tests (TSTs) with Interferon Gamma Release Assays (IGRAs)? NO
Session: Interactive Session: Clinical Controversies in Infectious Diseases
Friday, October 21, 2011: 3:15 PM
Room: Grand Ballroom (East-West)
The tuberculin skin test with purified protein derivative seems to be sinking into the sands of time, ready to become a fossil, but have we kept this antique diagnostic tool for any reason other than just the lack of a replacement? The skin test is an inexpensive, "low-tech," point-of-care method that adapts well to many U.S. healthcare settings, and it does forecast TB/not TB successfully. Decades of trial and error have improved the reliability of the tuberculin antigens and the collective skills of practitioners who administer and read the test. Until the many growing pains of the interferon-gamma release assays (blood tests) are resolved, the skin test remains the core diagnostic tool for latent Mycobacterium tuberculosis infection, and a positive result is still incorporated into the case definition for TB. Our assumptions about the utility of the tuberculin skin test, some of which are based on dogma more than evidence, have been transferred to the blood tests, and we should allow for the possibility of further clinical research with the skin test as well as with the blood tests, and direct comparisons between these types of test are the best strategy for all new research on either test.

John A. Jereb, MD, FAAP, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA

Dr. John A. Jereb is a medical epidemiologist in the Field Services and Evaluation Branch of the Division of Tuberculosis Elimination, CDC. He has participated in on-site TB outbreak investigations, data collection for contact investigations, clincial research in pharmacokinetics, and international progam evaluations. His residency was in pediatrics, and he learned epidemiology through the CDC EIS program. He began his work in TB control with the Indian Health Service.

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