{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:04:18Z","timestamp":1793124258427,"version":"4.5.0"},"reference-count":35,"publisher":"European Respiratory Society (ERS)","issue":"180","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir Rev"],"accepted":{"date-parts":[[2026,2,2]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The tuberculin skin test (TST), widely used for latent tuberculosis infection (LTBI) screening, shows reduced specificity in Bacillus Calmette\u2013Gu\u00e9rin (BCG)-vaccinated individuals due to antigenic cross-reactivity. We aimed to quantify the impact of BCG vaccination on false-positive TST results and to identify key modifying factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We systematically searched Embase, PubMed, Web of Science and the Cochrane Library up to 24 February 2025. A dual-comparison design was applied: head-to-head comparisons of interferon-\u03b3 release assay (IGRA)\n                      <jats:italic>versus<\/jats:italic>\n                      TST in BCG-vaccinated populations and between-group comparisons of TST positivity in vaccinated\n                      <jats:italic>versus<\/jats:italic>\n                      unvaccinated groups. Random-effects models were used to calculate risk differences (RDs) for false-positive results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 242 studies were included, with 166 head-to-head (50\u2009341 participants) and 176 between-group comparisons (456\u2009429 participants). Both approaches yielded consistent estimates, including a head-to-head RD of 13% (95% CI 9\u201316%) and a between-group RD of 12% (95% CI 9\u201314%). False positivity decreased with increasing tuberculosis incidence and latitude. Immunosuppressed individuals showed lower RDs than general populations. BCG strain, age at vaccination and number of doses significantly influenced false positivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We identified key modifiers of BCG-related TST false positivity. TST remains appropriate in high-incidence settings and for BCG specific strains, whereas IGRA may be preferred in low-incidence areas, in individuals vaccinated multiple times or in immunosuppressed individuals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/16000617.0204-2025","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T08:30:16Z","timestamp":1779870616000},"page":"250204","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Multidimensional determinants of BCG-induced false-positivity in tuberculin skin testing: a global meta-analysis of 242 studies"],"prefix":"10.1183","volume":"35","author":[{"given":"Shunli","family":"Cai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingchen","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangxuan","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbo","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guozhong","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"2026062507402073000_35.180.250204.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30248-7"},{"key":"2026062507402073000_35.180.250204.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1405427"},{"key":"2026062507402073000_35.180.250204.3","unstructured":"World Health Organization. The end TB strategy . Date last accessed: 10 May 2025. Date last updated: 2026. www.who.int\/teams\/global-programme-on-tuberculosis-and-lung-health\/the-end-tb-strategy"},{"key":"2026062507402073000_35.180.250204.4","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/j.ijid.2019.01.048","article-title":"Tuberculin skin test \u2013 outdated or still useful for latent TB infection screening","volume":"80S","author":"Gualano","year":"2019","journal-title":"Int J Infect Dis"},{"key":"2026062507402073000_35.180.250204.5","doi-asserted-by":"crossref","first-page":"106992","DOI":"10.1016\/j.ijid.2024.106992","article-title":"Is the new tuberculous antigen-based skin test ready for use as an alternative to tuberculin skin test\/interferon-gamma release assay for tuberculous diagnosis? A narrative review","volume":"141S","author":"To","year":"2024","journal-title":"Int J Infect Dis"},{"key":"2026062507402073000_35.180.250204.6","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e32813e3fd8"},{"key":"2026062507402073000_35.180.250204.7","unstructured":"European Centre for Disease Prevention and Control . Programmatic management of latent tuberculosis infection in the European Union. Date last accessed: 23 June 2024. Date last updated: 15 October 2018. www.ecdc.europa.eu\/en\/publications-data\/programmatic-management-latent-tuberculosis-infection-european-union"},{"key":"2026062507402073000_35.180.250204.8","unstructured":"Centers for Disease Control and Prevention. Latent tuberculosis infection: a guide for primary health care providers . Date last accessed: 22 April 2026. Date last updated: 2 April 2024. www.cdc.gov\/tb\/hcp\/education\/latent-tb-infection-guide-primary-care-providers.html"},{"key":"2026062507402073000_35.180.250204.9","doi-asserted-by":"crossref","first-page":"E322","DOI":"10.33321\/cdi.2017.41.43","article-title":"Position statement on interferon-\u03b3 release assays for the detection of latent tuberculosis infection","volume":"41","author":"Bastian","year":"2017","journal-title":"Commun Dis Intell Q Rep"},{"key":"2026062507402073000_35.180.250204.10","unstructured":"World Health Organization. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management . Date last accessed: 22 April 2026. 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