Tuberculosis remains endemic in many countries, and the risk of infection to international travelers visiting these destinations is unknown. Cobelens and colleagues studied the incidence of and risk factors for tuberculin skin test conversion among Bacille Calmette-Gue'rin (BCG)-naive Dutch travelers; all travelers spent three to 12 months in countries with an estimated annual risk of Mycobacterium tuberculosis infection of at least 1%. Among 656 travelers who had a negative pretravel purified protein derivative (PPD) skin test result, 1.8% had a positive post travel PPD skin test result. Risks of infection were 7.9 and 2.8 per 1,000 person-months of travel for health-care workers and non-health-care workers, respectively. Travelers to regions where tuberculosis is endemic have a risk of infection similar to the risk of the local population; physicians should advise travelers to obtain prophylactic BCG vaccination before travel or a tuberculin skin test after travel.
Praxis.MD Recommendations
Do not change current skin-testing procedures based on this information.
If a traveler has come into contact with someone with known or suspected active tuberculosis, administer a skin test.
Be aware that travelers may introduce TB into countries where this disease is rare, such as the United States or Western Europe.
Those who are infected during travel should be treated early in order to prevent further spread of TB upon return.
Read the American Thoracic Society guidelines on targeted tuberculin testing and treatment of latent tuberculosis infection (see references) for more information.
References and Links
Cobelens FGJ, van Deutekom H, Drayer-Jansen IWE, et al.: Risk of infection with Mycobacterium tuberculosis in travellers to areas of high tuberculosis endemicity. Lancet. 2000 Aug 5;356(9228):461-5.[abstract]. See also editorial.
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