When is referral of Heaf test positive schoolchildren worth while? Prospective study

Recent guidelines for controlling and preventing tuberculosis recommend that no further action is required for children with a grade 2 reaction to Heaf testing in the school pre-BCG screening programme.1 Fifty seven per cent of district health authorities, however, still recommend referral for such children.2 Furthermore, no guidance is given regarding contact tracing of children who are confirmed to be tuberculin positive but who have no signs or symptoms of clinical disease. We prospectively studied the results of screening children referred to our childhood tuberculosis clinic after a positive school Heaf test from January 1991 to August 1994 and tracing the contacts of these children. Newcastle Health Authority currently recommends referral of children with a positive Heaf test result of grade 2 or above to our childhood tuberculosis clinic. Tuberculin sensitivity is confirmed with a Mantoux test: 0.1 ml of 1:1000 purified protein derivative, read after 72 hours. …