Comparison of Heaf and Mantoux Tests in the Cali Area of Colombia

Abstract

IN DECEMBER 1959, the Arden House Conference on Tuberculosis emphasized the need for a simple and accurate tuberculin test that could be applied and read by nonprofessional health personnel (1). This need is greatest in developing countries where tuberculosis is, often a major public health problem and professionial health personnel a,re in short supply. In Colombia, although the exact magnitude of the tuberculosis problem is still unknown, substantial evidence indicates that the diseiase is a major cause oif disability and death. In 1951, Dr. Frederick Heaf (2) published his technique for a multiple-puncture tuberculin test that seemed to have several advantages over the routine Mantoux procedure: not only did it prove relatively consistent, it was also cheap, it could be administered rapidly, and results were easy to read. The Heaf test was subsequently tried out in Great Britain and the Commonwealth with encouraging results. This method is not widely used in the United States, however, despite the publications of Robins and Daly (3), Andersen and Smith (4), Coulter and Martin (5), and Hsu (6). In February 1961, during a morbidity survey in the rural town of Candelaria, Valle, Colombia, we carried out a series of Heaf tests on a random sample of the population that included all ages. The tests were included in the survey at the suggestion of Dr. Robert M. Lennox, then visiting professor of pediatrics at the Universidad del Valle and now professor of child health, Tulane University School of Medicine. Shortly thereafter, we tested a small group of school children in Candelaria with both Heaf and Mantoux techniques. The results encouraged us to carry out a more extensive field trial of the two methods in 1962 and 1963. The primary objective of this study was to compare Heaf and Mantoux tests in individual subjects. For our purposes, diagnostic implications of the test results were a side issue. Subjects for the field trial, in addition to the school children of Candelaria, were from the cities of Cali, Yumbo, and Palmira. Cali (population about 700,000) is located at an altitude of 3,300 feet in the Cauca Valley, between the Central and Western Cordilleras; Yumbo (population 11,500) and Palmira (population 150,000) are both within 15 miles of Cali and at the same elevation. Candelaria is a nearby rural town (population 22,000) at the same elevation. The subjects included adult and pediatric patients at a university hospital, a general hospital, three tuberculosis sanatoriums, and also medical and nursing students, interns, residents, and staff nurses of the university hospital.