The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letter to the editor
Editor, – In their articles on BCG vaccination (Aust Prescr 2003;26:144-6), neither Professor Simpson nor Air Vice-Marshal Short mentioned the potential for tuberculosis control offered by modern tuberculosis-specific tests that are unaffected by BCG vaccination. T-cell mediated immune responses to the tuberculosis-specific proteins ESAT-6 and CFP-10 (proteins not present in BCG or environmental mycobacteria) have been shown to be effective in diagnosing tuberculosis infection in BCG-vaccinated individuals.12
Unfortunately, despite intense interest in the literature, the use of tuberculosis-specific antigens in diagnostics has to date been limited by the complexity of the methodologies required to measure T-cell responses. Most methods require T-cell purification, counting, and culture, which are expensive and not suited for reproducible, robust diagnosis. However, the whole blood test, QuantiFERON-TB Gold, has now been released in Australia, after extensive testing overseas found it to have high specificity and sensitivity.
The Australian Defence Force may also note the US Centers for Disease Control endorses QuantiFERON-TB testing in the military.3 QuantiFERON testing detects significantly more active, infectious tuberculosis cases than Mantoux testing.4 The elimination of the confounding factors of BCG vaccination and sensitisation to non-tuberculous mycobacteria makes the test an even more valuable diagnostic tool.
Chief Executive Officer/Managing Director
(Cellestis are manufacturers of QuantiFERON products)
Letter to the editor
Editor, – I noted with interest the photo illustrating the article 'BCG vaccine in Australia' (Aust Prescr 2003;26:144-6). What has happened to universal infection control precautions - surely the person administering the injection should have been wearing gloves?
Sydney Sexual Health Centre
- Andersen P, Munk ME, Pollock JM, Doherty TM. Specific immune-based diagnosis of tuberculosis. Lancet 2000;356:1099-104.
- Doherty TM, Demissie A, Olobo J, Wolday D, Britton S, Eguale T, et al. Immune responses to the Mycobacterium tuberculosis-specific antigen ESAT-6 signal subclinical infection among contacts of tuberculosis patients. J Clin Microbiol 2002;40:704-6.
- Mazurek GH, Villarino ME. Guidelines for using the QuantiFERON(R)-TB test for diagnosing latent Mycobacterium tuberculosis infection. Centers for Disease Control and Prevention. MMWR 2003 Jan 31;52(RR-2):15-8.
- Fietta A, Meloni F, Cascina A, Morosini M, Marena C, Troupioti P, et al. Comparison of a whole-blood interferon-gamma assay and tuberculin skin testing in patients with active tuberculosis and individuals at high or low risk of Mycobacterium tuberculosis infection. Am J Infect Control 2003;31:347-53.
- Ewer K, Deeks J, Alvarez L, Bryant G, Waller S, Andersen P, et al. Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak. Lancet 2003;361:1168-73.