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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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Azoulay D, Abiteboul D, Gangloff C, Devaux M, Bouvet E, Causse E, Cherifi C. Suivi d’une cohorte de personnels hospitaliers ayant un test QuantiFERON-TB Gold In-Tube® positif pendant deux ans. ARCH MAL PROF ENVIRO 2015. [DOI: 10.1016/j.admp.2015.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nienhaus A, Gariepy PK, Trouve C, Lhaumet C, Toureau J, Peters C. Tuberculosis screening at the Sainte-Anne Hospital in Paris - results of first and second IGRA. J Occup Med Toxicol 2014; 9:24. [PMID: 25018775 PMCID: PMC4094665 DOI: 10.1186/1745-6673-9-24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/02/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Healthcare workers (HCWs) are exposed to Mycobacterium tuberculosis (MTB) and therefore are screened for tuberculosis (TB). Results of TB screenings with the Interferon-γ Release Assay (IGRA) in a French psychiatric hospital without a TB ward are described. METHODS At the Sainte-Anne Hospital, a referral centre for psychiatric patients throughout the municipal region of Paris, IGRA screening is performed during pre-employment and general health examination or after potential contact to MTB. The QuantiFERON Gold in tube (QFT) is used and data on TB history are assessed in a standardized manner. RESULTS Between August 2008 und August 2013 in total 1.192 HCWs were tested and the QFT was positive in 265 (22.2%). Probability of a positive QFT increased with age. A second QFT was performed in 144 HCWs with a positive QFT and 53 (36.8%) HCWs had a reversion. With a positive QFT close to the cut-off (e.g. 0.35-0.7 IU/ml) the odds ratio for a reversion was 4.6 compared to an INF-γ concentration of ≥3.0 IU/ml. Probability of reversion was not influenced by preventive chemotherapy, which was completed by 28 (19.4%) HCWs with a positive QFT. No active TB was detected. CONCLUSION Prevalence of positive IGRA is high in French HCWs as is the number of reversions in IGRA. Reversion rate is particularly high around the cut-off of the IGRA. A borderline zone will therefore reduce the influence of test variability.
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Affiliation(s)
- Albert Nienhaus
- Center of Excellence for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Principles of Prevention and Rehabilitation Department (GPR), Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
- Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Paul-Kenneth Gariepy
- Department of Occupational Safety and Health, Sainte-Anne Hospital, Paris, France
| | - Catherine Trouve
- Department of Occupational Safety and Health, Sainte-Anne Hospital, Paris, France
| | - Christiane Lhaumet
- Department of Occupational Safety and Health, Sainte-Anne Hospital, Paris, France
| | - Jean Toureau
- Department of Occupational Safety and Health, Sainte-Anne Hospital, Paris, France
| | - Claudia Peters
- Center of Excellence for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Moucaut A, Nienhaus A, Courtois B, Nael V, Longuenesse C, Ripault B, Rucay P, Moisan S, Roquelaure Y, Tripodi D. The effect of introducing IGRA to screen French healthcare workers for tuberculosis and potential conclusions for the work organisation. J Occup Med Toxicol 2013; 8:12. [PMID: 23647777 PMCID: PMC3651707 DOI: 10.1186/1745-6673-8-12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 04/30/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In France, pre-employment screening for tuberculosis (TB) is performed for healthcare workers (HCW). Screening is repeated when exposure to TB patients or infectious material occurs. The results of these TB screenings were analysed in a retrospective analysis. METHOD Tuberculin skin tests (TST) and interferon-gamma release assays (QuantiFERON® Gold In-Tube - QFT) were used to perform the TB screenings. The screening results of 637 HCWs on whom QFT was performed were taken from the records of the University Hospital of Nantes. RESULTS In three (0.5%) HCW, the QFT was indeterminate. In 22.2%, the QFT was positive. A second QFT was performed in 118 HCWs. The reversion rate was 42% (5 out of 17). The conversion rate was 6% (6 out of 98). A TST was performed on 466 (73.5%) of the HCWs. Results for TST > 10 mm were 77.4%. In those with a TST < 10 mm, QFT was positive in 14% and in those with a TST ≥ 10 mm, QFT was positive in 26.7%. Depending on the definition for conversion in the QFT, the annual attack rate was 4.1% or 7.3%. X-ray and pneumology consultation was based on positive QFT rather than TST alone (52 out of 56). No active TB was detected. CONCLUSION The TST overestimated the prevalence of LTBI in this cohort. The decision about X-ray and consultation regarding preventive treatment should be based on the QFT rather than the TST results. The high reversion rate should be taken into consideration when consulting with HCWs regarding preventive treatment. The high conversion rate seems to indicate that preventive measures such as wearing masks should be improved.
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Affiliation(s)
- Adrien Moucaut
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, Nantes, France
| | - Albert Nienhaus
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Clinic Hamburg-Eppendorf, Hamburg, Germany
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany
| | - Benedicte Courtois
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, Nantes, France
| | - Virginie Nael
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, Nantes, France
| | - Claire Longuenesse
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, Nantes, France
| | - Bruno Ripault
- Laboratory of Ergonomics and Epidemiology in Occupational Health, LEEST-UA InVS - IFR 132- UPRES EA 4336, University of Angers, Angers, France
- Faculty of Medicine Medicine E, University Hospital, 4 rue Larrey, Angers cedex, F 49933, France
| | - Pierre Rucay
- Laboratory of Ergonomics and Epidemiology in Occupational Health, LEEST-UA InVS - IFR 132- UPRES EA 4336, University of Angers, Angers, France
- Faculty of Medicine Medicine E, University Hospital, 4 rue Larrey, Angers cedex, F 49933, France
| | - Stéphanie Moisan
- Laboratory of Ergonomics and Epidemiology in Occupational Health, LEEST-UA InVS - IFR 132- UPRES EA 4336, University of Angers, Angers, France
- Faculty of Medicine Medicine E, University Hospital, 4 rue Larrey, Angers cedex, F 49933, France
| | - Yves Roquelaure
- Laboratory of Ergonomics and Epidemiology in Occupational Health, LEEST-UA InVS - IFR 132- UPRES EA 4336, University of Angers, Angers, France
- Faculty of Medicine Medicine E, University Hospital, 4 rue Larrey, Angers cedex, F 49933, France
| | - Dominique Tripodi
- Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, Nantes, France
- Laboratory of Ergonomics and Epidemiology in Occupational Health, LEEST-UA InVS - IFR 132- UPRES EA 4336, University of Angers, Angers, France
- Faculty of Medicine Medicine E, University Hospital, 4 rue Larrey, Angers cedex, F 49933, France
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