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The Heaf test, a diagnostic skin test, is performed to determine whether or not a child has been exposed to tuberculosis. Also known as the Sterneedle test, it is administered by a Heaf gun (trademarked "Sterneedle") which is a spring-loaded instrument with six needles arranged in a circular formation.
Patients who exhibit a negative reaction to the test may be offered BCG vaccination. The test is named after F. R. G. Heaf. Until 2005, the test was used in the United Kingdom to determine if the BCG vaccine was needed; the Mantoux test is now used instead. The Heaf test was preferred in the UK, because the Heaf test was thought to be easier to interpret, with less variability between observers, and less training was required to administer and read the test. The test was withdrawn because manufacturers could not be found for tuberculin or Heaf guns.
A Heaf gun is used to inject multiple samples of testing serum under the skin at once. The needle points are dipped in tuberculin purified protein derivative (PPD) and pricked into the skin. A Heaf gun with disposable single-use heads is recommended.
The gun injects PPD equivalent to 100,000 units per ml to the skin over the flexor surface of the left forearm in a circular pattern of six. The test is read between two and seven days later. The injection must not be into sites containing superficial veins.
The reading of the Heaf test is defined by a scale:
- Negative - No induration, maybe six minute puncture scars
- Grade 1 - four to six papules (also considered negative)
- Grade 2 - Confluent papules form indurated ring (positive)
- Grade 3 - Central filling to form disc (positive)
- Grade 4 - Disc >10 mm with or without blistering (strongly positive)
Grades 1 and 2 may be the result of previous BCG or avian tuberculosis.
Children who have a grade 3 or 4 reaction require X-ray and follow-up.
For interpretation of the test, see Tuberculosis diagnosis.
Other tests 
The equivalent Mantoux test positive levels done with 10 TU (0.1 mL 100 TU/mL, 1:1000) are
- 0–4 mm induration (Heaf 0-1)
- 5–14 mm induration (Heaf 2)
- >15 mm induration (Heaf 3-4)
- Joint Tuberculosis Committee of the British Thoracic Society, Control and prevention of tuberculosis in the United Kingdom: Code of Practice 2000 BMJ 2000:55:887-901. Table 3 Heaf Test grading, reaction, and equivalent Mantoux positive levels. doi:10.1136/thorax.55.11.887 PMID 11050256
- Nolan, Thomas E. (1996). Primary care for the obstetrician and gynecologist. Wiley-IEEE. p. 285. ISBN 978-0-471-12279-1. Retrieved 17 October 2010.
- "Test substance for tuberculosis". United States Patent and Trademark Office. 13 July 1976. Retrieved 17 October 2010. "...multiple scratch scarifications by an instrument known as the Heaf gun (also known by the Trademark "Sterneedle"), or by..."
- "Heaf Test". Black's Medical Dictionary, 42nd Edition. London: A & C Black. 2010. Retrieved 17 October 2010. (subscription required)
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- "Sterneedle test". Academic Press Dictionary of Science and Technology. Oxford: Elsevier Science & Technology. 1992. Retrieved 17 October 2010. (subscription required)