1654. BCG Vaccination and LTBI Treatment Attitudes among Resident Physicians
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Yates_IDSA LTBI poster 9_19_13.pdf (1.2 MB)
  • Background:

    Previous studies have demonstrated that foreign-born physicians in the U.S. are less accepting of latent tuberculosis infection (LTBI) treatment among themselves and their patients. It is uncertain whether these differences are motivated by differences in medical education or by cultural beliefs regarding BCG vaccination. Our objective was to determine whether a resident physician’s decision to treat LTBI under various scenarios was associated with their personal history of BCG vaccination.

    Methods:

    We surveyed internal medicine residents from a single academic medical center regarding their personal history of LTBI, as well as their attitudes towards LTBI diagnosis and treatment in their patients. We queried country of birth, year of birth, and country of medical school training. The BCG World Atlas (www.bcgatlas.org) was used to ascertain the personal history of BCG vaccination for all respondents, based on country and year of birth.

    Results:

    103 of 140 residents (74%) responded to the survey. Among 32 respondents that were born outside the U.S., 28 (88%) were assigned a personal history of BCG vaccination. There were 13 respondents with a history of LTBI, and 3 of 13 (23%) reported completing treatment. Among 86 respondents without a history of LTBI, 67 (78%) would accept LTBI treatment based on a positive TST, while 79 (92%) would accept treatment based on a positive IGRA (p<0.05). 63 of 98 respondents (64%) would not recommend LTBI treatment for a BCG-vaccinated individual with a first-ever positive TST. Among these 63 respondents, 31 of 43 (72%) without a personal history of BCG vaccination would offer LTBI treatment to a BCG-vaccinated individual with a first-ever positive IGRA, and 19 of 20 (95%) with a personal history of BCG vaccination would offer treatment in the same scenario (p<0.05). 

    Conclusion:

    A resident’s personal history of BCG vaccination was associated with acceptance of LTBI treatment in their patients, with BCG-vaccinated residents placing greater weight on a positive IGRA. Future work will determine whether it is the personal history of BCG vaccination or other co-linear factors (such as their country of birth or country of medical school) that motivate attitudes towards LTBI treatment among resident physicians.

    Franklin Yates, MD, Infectious Diseases, Drexel University College of Medicine / Hahnemann University Hospital, Philadelphia, PA, Darren Linkin, MD, MSCE, Infectious Diseases, University of Pennsylvania, Philadelphia, PA and Christopher Vinnard, MD, Department of Medicine, Division of Infectious Diseases & HIV Medicine, Drexel University College of Medicine, Philadelphia, PA

    Disclosures:

    F. Yates, None

    D. Linkin, None

    C. Vinnard, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.