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Godoy P. Guidelines on controlling latent tuberculosis infection to support tuberculosis elimination. ACTA ACUST UNITED AC 2021; 23:28-36. [PMID: 33847703 PMCID: PMC8278168 DOI: 10.18176/resp.00028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 01/08/2021] [Indexed: 01/01/2023]
Abstract
Objectives Latent TB infection (LTBI) affects 25% of the world’s population. As long as this reservoir exists, the elimination of TB will not be feasible. The Assembly of the World Health Organization adopted the “Global End TB” strategy for the elimination of TB in 2014. The objective of this review is to present strategies for risk groups that are candidates for the detection and treatment of LTBI. Material and method There is sufficient evidence of screening in: immunocompromised people (HIV-infected, biological therapies, alternative renal therapy, organ transplantation), recent immigrants, inmates in prison, people injecting drugs and homeless people, and workers from at-risk settings. Tests to diagnose LTBI include tuberculin skin test (TST) and gamma release assay interferon (IGRA). There is no reference test and the choice of one or the other will depend on logistical considerations, such as avoiding injection (TST) or not needing a second visit (IGRA). Treatment of LTBI is based on the use of isoniazide and rifampicin in short period of 3 or 4 months, using associations of rifampicin and isoniazide or rifampicin alone. Discussion Given the estimated high prevalence of LTBI, renewed efforts are required to reduce the number of people with LTBI that includes a registration and monitoring system to observer progress, increased testing, and the use of short treatment guidelines.
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Affiliation(s)
- P Godoy
- Public Health Emergencies Epidemiological Monitoring and Response Service in Lleida and Alto Pirineo and Aran. Public Health Agency of Catalonia.,Biomedical Research Centre Network of Epidemiology and Public Health (CIBERESP). Carlos III Health Institute.,Lleida Biomedical Research Institute (IRBLleida)
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Casas I, Esteve M, Guerola R, Latorre I, Villar-Hernández R, Mena G, Prat-Aymerich C, Matllo J, Dominguez J. Serial testing of health care workers for tuberculosis infection: A prospective cohort study. PLoS One 2020; 15:e0235986. [PMID: 32678856 PMCID: PMC7367452 DOI: 10.1371/journal.pone.0235986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022] Open
Abstract
Health Care Workers (HCW) may have an occupational risk of latent tuberculosis infection (LTBI) and TB disease. The objective of this study was to evaluate the performance of the 2-step strategy: tuberculin skin test (TST) followed by confirmation with Interferon (IFN)-γ- release assays (IGRAs) in HCW. A secondary objective was to determine the factors related to conversions and reversions. HCW at risk of occupational exposure who attended the Occupational Department of the Hospital Germans Trias i Pujol were included during the study period (2013-2016). All professionals testing negative for LTBI were included in a cohort study. These workers were followed up with the administration of a TST and an IGRA quantification at least one year after inclusion in the study. Workers with positive TST, regardless of the results of the IGRA tests, were followed-up with an IGRA. 255 workers were enrolled in the study and 108 workers from the same cohort were followed up. During the follow-up period, seven workers presented TST test conversion. One of these conversions was also confirmed by an IGRA test. There were 2 conversions of cases only testing positive with the IGRA. There have been only 2 reversions of cases testing negative with the IGRA. In this study, not all TST conversions were confirmed when using the IGRA test, which highlights the importance of the 2-step strategy. We have detected a low number of conversions and reversions. Our conclusions should be confirmed in studies with a longer follow-up time.
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Affiliation(s)
- Irma Casas
- Servei de Medicina Preventiva, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Esteve
- Servei de Medicina Preventiva, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Guerola
- Servei de Medicina Preventiva, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Irene Latorre
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Villar-Hernández
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Guillermo Mena
- Servei de Medicina Preventiva, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Prat-Aymerich
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joan Matllo
- Unitat de Salut Laboral, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Barcelona, Spain
| | - Jose Dominguez
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Servei de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d’Investigació Germans Trias i Pujol, Barcelona, Spain
- CIBER Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain
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Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries-A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020581. [PMID: 31963207 PMCID: PMC7027002 DOI: 10.3390/ijerph17020581] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 11/17/2022]
Abstract
Healthcare workers (HCWs) have increased risk for latent tuberculosis infection (LTBI) and tuberculosis (TB) disease due to their occupational exposure. For some years now, interferon-γ release assays (IGRAs) have replaced the tuberculin skin test for the diagnosis of LTBI in many countries. This review examined the occupational risk of LTBI in HCWs with IGRA testing in low incidence countries. A systematic review and meta-analysis of studies from 2005 onwards provide data regarding the prevalence of LTBI in HCWs. In addition, the pooled effect estimates were calculated for individual regions and occupational groups. 57 studies with 31,431 HCWs from four regions and a total of 25 countries were analysed. The prevalence of LTBI varied from 0.9 to 85.5%. The pooled estimation found the lowest prevalence of LTBI for North American and West Pacific countries (<5%), and the highest prevalence for Eastern Mediterranean countries (19.4%). An increased risk for LTBI was found only for administrative employees. Studies on the occupational risk of LTBI continue to show increased prevalence of HCWs, even in low-incidence countries. Good quality studies will continue to be needed to describe occupational exposure.
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Serre-Delcor N, Treviño-Maruri B, Tórtola MT, Fernández-Quevedo M, Soriano-Arandes A, Oliveira-Souto I, Espasa M, Molina I, Ascaso C. Estrategia secuencial para el cribado de la ITBL en inmigrantes recién llegados en situación social vulnerable. Enferm Infecc Microbiol Clin 2018; 36:550-554. [DOI: 10.1016/j.eimc.2017.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/12/2017] [Indexed: 11/26/2022]
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Serre-Delcor N, Ascaso C, Soriano-Arandes A, Collazos-Sanchez F, Treviño-Maruri B, Sulleiro E, Pou-Ciruelo D, Bocanegra-Garcia C, Molina-Romero I. Health Status of Asylum Seekers, Spain. Am J Trop Med Hyg 2018; 98:300-307. [PMID: 29165223 DOI: 10.4269/ajtmh.17-0438] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The rising rate of conflicts and the unsafe situation caused by reasons of ethnicity, religion, gender, sexual orientation, political opinion, or nationality entail an increase in the number of migratory movements. The goal of this article is to describe the health status of asylum seekers visited in an international health center. We conducted a retrospective study of the asylum seekers visited between July 2013 and June 2016. A total of 303 cases were included. The median age was 28.0 years (interquartile range [IQR]: 21-35), and 203 (67.0%) were men. Of the total, 128 cases (42.2%) were from Asia, 82 (27.1%) from Eastern Europe, 42 (13.9%) from sub-Saharan Africa, 34 (11.2%) from America, and 17 (5.6%) from Maghreb. The majority, 287 (94.7%), were asymptomatic. Seventy of the 303 (23.1%) cases were diagnosed with at least one infection, this being more prevalent in men; migrants from sub-Saharan Africa; and in those who took a land-maritime migratory route. Eight of the 303 (2.6%) cases were referred to the transcultural psychiatric department. Two important challenges of the study were the communication barriers and the legal or social situation that condition the psychological symptoms. In 48 of the 303 (15.8%) cases, there was diagnosed a noncommunicable diseases. The process of care was completed by 82.5%; although 21.9% completed the vaccination for hepatitis B. The asylum seekers in this study were in general healthy young men, although special attention was given to infectious diseases with certain geoepidemiological backgrounds. Unstable living arrangements, linguistic, and cultural barriers could account for the failure of the course of care.
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Affiliation(s)
- Núria Serre-Delcor
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes, PROSICS, Hospital Universitari Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Carlos Ascaso
- Department of Basic Clinical Practice, Institut de Investigacions biomédiques August Pi i Sunyer, Barcelona, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases Unit, PROSICS, Hospital Universitari Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Francisco Collazos-Sanchez
- Department of Psychiatric, PROSICS, Hospital Universitari Vall d'Hebron, CIBERSAM, Institut Català de la Salut, Barcelona, Spain and Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Begoña Treviño-Maruri
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes, PROSICS, Hospital Universitari Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, PROSICS, Hospital Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Diana Pou-Ciruelo
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes, PROSICS, Hospital Universitari Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Cristina Bocanegra-Garcia
- Tropical Medicine and International Health Unit Vall d'Hebron-Drassanes, PROSICS, Hospital Universitari Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
| | - Israel Molina-Romero
- Department of Infectious Diseases, PROSICS, Hospital Vall d'Hebron, Institut Català de la Salut, Barcelona, Spain
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