"The U.S. Food and Drug Administration today approved Dotarem (gadoterate meglumine) for use in magnetic resonance imaging (MRI) of the brain, spine and associated tissues of patients ages 2 years and older.
Dotarem is a gadolinium-based"...
(Generic versions may still be available.)
The Mono-Vacc ®Test (O.T.) is indicated for the detection of tuberculin sensitivity in high risk children: including American Indian and Alaskan native children, children living in neighborhoods where the case rate is higher than the national average; children from, or whose parents have immigrated from Asia, Africa, the Middle East, Latin America, or the Caribbean; and children in households with one or more cases of tuberculosis. 1
Annual testing of low-risk groups (from areas of low prevalence) is not indicated. 1,2 In low-risk groups, a reasonable alternative to no routine testing is to perform skin tests at three stages of childhood and adolescence which coincide with routine health appraisals or immunizations: (1) at 12 to 15 months of age (before or at the time of administration of measles-mumps-rubella (MMR), before school entry (4 to 6 years of age), and (2) in adolescence (at 14 to 16 years of age). The tuberculin skin test is always indicated for individuals with known contact with a person with tuberculous disease; if the test is negative, it should be repeated 8 to 10 weeks after separation from the contact. 1
The following groups also are recommended to be screened for tuberculosis and tuberculous infection: 3
2. Persons with medical risk factors known to increase the risk of disease if infection has occurred. 3
3. Alcoholics and intravenous drug users. 3
4. Residents of long-term-care facilities, correctional institutions, mental institutions, nursing homes/facilities, and other long-term residential facilities. 3
Since this test is a screening procedure, positive Mono-Vacc ®Test (O.T.) reactions should be confirmed by a 5 TU Tuberculin, PPD Mantoux Test (intradermal) and possibly other diagnostic test procedures.
The need for repeat skin testing should be determined by the likelihood of exposure to infectious tuberculosis. All tuberculin-negative individuals in high-risk groups should be retested if exposure to an infectious case occurs. In some institutional and group-living environments (e. g., hospitals, prisons, nursing homes, shelters for the homeless), the risk of exposure is probably high enough to justify repeat testing at 6 to 24-month intervals. 3
Repeated testing of the uninfected individual does not sensitize to tuberculin. 3
DOSAGE AND ADMINISTRATION
The activity per test is comparable to or greater than 5 tuberculin units (5 TU) administrated by the Mantoux method.
Discard the Mono-Vacc® Test (O.T.) after use.
DO NOT REUSE.
Directions for Application of Mono-Vacc® Test (O.T.):
3. While twisting the cap, carefully pull it away from the points.
4. With skin taut, press the loaded points firmly into the cleansed site. With proper pressure of the punctures, an imprint of the base and liquid tuberculin are visible.
Reading the Reaction
The test should be read 48 to 96 hours following administration. Local erythema may or may not be observed with a positive reaction. Erythema should be disregarded. The sole criterion for a positive reaction is palpable induration. The presence of palpable induration (even 1 to 2 mm) indicates a positive reaction. A negative reaction is indicated by complete absence of induration. As with all screening procedures, positive Mono-Vacc ®Test (O.T.) reactions should be confirmed by a standard Mantoux (PPD, 5 TU) Test and possibly other diagnostic test procedures such as chest x-ray and microbiological examination of sputa and other specimens. A significant reaction to the tuberculin skin test indicates the presence of infection but does not signify disease. The test is only a diagnostic aid in the evaluation of an individual patient.
Descriptive literature illustrating typical reactions is available on request.
Advantages of Mono-Vacc® Test (O.T.):
1. The Mono-Vacc® Test (O.T.) employs liquid tuberculin for instantaneous administration, eliminating two variables associated with dried tuberculin † the length of time tines are held in the skin, and the moisture content of the skin.
2. The uniform presence of liquid tuberculin on each Mono-Vacc ®Test (O.T.) is visually assured by the user.
3. The Mono-Vacc ®Test (O.T.) has consistently shown a high level of sensitivity when compared to intradermal PPD 5 TU. 4-10 The risk of false negative results from the Mono-Vacc ®Test (O.T.) is not statistically significant. 4,5,8,9 In contrast, reported false negative results from multiple puncture tests containing tuberculin dried on the tines has ranged from a low to significant incidence. 5,10-12
4. The Tuberculin, Mono-Vacc® Test (O.T.) produces a well defined single, usually circular reaction that is easy to read. 4,6-9
A multiple puncture test utilizing tuberculin dried on the tines may produce one, two, three or four separate reactions of varying size, or two or more reactions may coalesce.
5. The Mono-Vacc ®Test (O.T.) utilizes old tuberculin because concentrated old tuberculin is considered very stable under ordinary conditions of storage. 10 There are no reliable data supporting greater specificity of purified protein derivative (PPD) over old tuberculin (O.T.).
6. The Mono-Vacc®Test (O.T.) rarely produces bleeding upon administration and is well accepted by patients.
Box of 25 tests.
Store at 15° to 30° C (59° to 86° F).
1. Report of the Committee of Infectious Diseases (Red Book), pp 429- 447, American Academy of Pediatrics (1988).
2. Recommendations of the Advisory Committee for Elimination of Tuberculosis. Screening for tuberculosis and tuberculous infection in high- risk populations. MMWR 39: Vol 39, No. RR- 8 (1990).
3. Diagnostic Standards and Classification of Tuberculosis and other Mycobacterial Diseases, Amer. Rev. Resp. Dis., Sept 1990, pp 726- 735.
4. Kravitz H, Burg F, Lawson R: Skin testing with liquid oil tuberculin with a multiple puncture technique. Pediatrics42: 465- 470 (1968).
5. Donaldson JC, Elliott RC: A study of copositivity of three multipuncture techniques with intradermal PPD tuberculin. Amer Rev Respir Dis118: 843- 846 (1978).
6. Stocker JA: Comparison of multiple puncture tuberculin test with purified protein derivative. Amer Rev Respir Dis96: 1067- 1068 (1967).
7. Grabau AA: Comparison of tuberculin testing between MONO- VACC and Mantoux. Dis Chest55: 411- 414 (1969).
8. Rouhe S, Tupper G, Yahiku P, and West RO: Comparison of Mantoux and Mono- Vacc tests. Med Digest20: 25- 33 (1974).
9. Byrd RB, Gracey DR, Campbell, Jr., DC, and Knies AA: The Mono- Vacc tuberculin skin test. Dis Chest 56: 447- 449 (1969).
10. Federal Register42: 52674- 52723 (1977).
11.Herzog D: Multiple- puncture tuberculin testing: Reason for variable response to tine test. Tubercle62: 249- 256 (1981).
12. Lunn JA, Johnson AJ: Comparison of the tine and Mantoux Tuberculin Tests. Brit Med J1: 1451- 1453 (1978).
Last reviewed on RxList: 12/8/2004
This monograph has been modified to include the generic and brand name in many instances.
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