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Kuan MM. Surveillance of tuberculosis and treatment outcomes following screening and therapy interventions among marriage-migrants and labor-migrants from high TB endemic countries in Taiwan. PeerJ 2021; 9:e10332. [PMID: 33777506 PMCID: PMC7977376 DOI: 10.7717/peerj.10332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background Tuberculosis (TB) among migrants from high-risk countries and underling interventions were concerned for disease control. This study aimed to assess the TB trends among marriage-migrants with the 1–2-round vs. labor-migrants with the four-round TB screenings in the period of the first four post-entry years; pre-entry screenings by an initial chest X-ray (CXR) were conducted during 2012–2015, and a friendly treatment policy was introduced in 2014. Methods TB data of migrants during 2012–2015 were obtained from the National TB Registry Database and analyzed. The incidences, clinical characteristics, and treatment outcomes were assessed to explore the impact of underlying interventions. Results During post-entry 0–4 years, the TB incidence rates among marriage-migrants ranged 11–90 per 100,000 person-years, with 60.8% bacteria-positive and 28.2% smear-positive cases. Whereas among labor migrants, the incidence rates ranged 67–120 per 100,000 person-years, with 43.6% bacteria-positive and 13.7% smear-positive cases. All migrants originated from Southeast Asia following pre-entry health screening in 2012–2015. The TB cases among marriage-migrants were with a higher proportion of sputum-smear-positivity (SS+) (OR: 4.82, 95% CI [3.7–6.34]) and CXR cavitation (OR: 2.90, 95% CI [2.10–4.01]). Marriage-migrants with TB had treatment completion rate of >90%, which was above the WHO target. For labor-migrants with TB, when compared the period of post- vs. pre-implementation of the friendly therapy policy that eliminated compulsory repatriation, the overall treatment completion rate of those who stayed in Taiwan improved by 30.9% (95% CI [24.3–37.6]) vs. 6.7% (95% CI [3.8–9.7]), which exceeded a 4.88-fold (95% CI: 3.83–6.22) improvement. Additionally, the treatment initiation rate within 30 days of diagnosis for SS- TB and B- TB cases during post- vs. pre-implementation of the therapy policy was increased, that is, 77.1% vs. 70.9% (OR: 1.38, 95% CI [1.12–1.70]) and 78% vs. 77% (OR: 1.64, 95% CI [1.38–1.95]). Conclusion Multiple CXR screenings could identify more TB cases with sputum-smear-negativity (SS-) TB at the early-stage, introducing latent tuberculosis infection (LTBI) screening might save underlying efforts. For those labor-migrants with TB who stayed in the receiving country, the friendly TB therapy policy not only significantly improved the treatment completion but also the early treatment initiation.
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Affiliation(s)
- Mei-Mei Kuan
- Chief Secretary Office, Taiwan Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
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Mahmoudi S, Pourakbari B, Sadeghi RH, Hamidieh AA, Safari Sharari A, Salajegheh P, Aziz-Ahari A, Mamishi S. High prevalence of latent tuberculosis in hematopoietic stem cell transplant recipients: A First Report. Pediatr Transplant 2020; 24:e13770. [PMID: 32573900 DOI: 10.1111/petr.13770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/14/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Abstract
TB is an increasing health problem, and patients undergoing HSCT are more prone to develop tuberculosis. The aim of our study was to evaluate prevalence of latent tuberculosis in HSCT recipients. In this study, 84 patients (2 months to 18 years) who were candidates for HSCT at the referral hospital of Tehran Children's Medical Center were enrolled. The TST and the QFT-GIT test were performed in all 84 patients, simultaneously. LTBI was considered when one of the tests was positive. Overall, the prevalence of LTBI in HSCT recipients in our study was 12% (10 cases). TST induration ≥5 mm was seen in only three patients (3.5%). Eight patients (9.5%) had a positive result for IGRA test, and 11 of them (13%) had indeterminate QFT-GIT result. The agreement between the TST results (induration size ≥5 mm) and the QFT-GIT results was poor (kappa = 0.14). In conclusion, there was a high rate of discordance between TST and IGRA results with many more positive QFT-GIT tests. However, more studies are needed in this population to determine whether this discordance reflects true infection.
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Affiliation(s)
- Shima Mahmoudi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran
| | | | - Amir Ali Hamidieh
- Pediatric Cell Therapy Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alieh Safari Sharari
- Department of Pediatrics, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouria Salajegheh
- Department of Pediatric Hematology-Oncology, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Aziz-Ahari
- Radiology Department, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Setareh Mamishi
- Pediatric Infectious Disease Research Center, Tehran University of Medical Science, Tehran, Iran.,Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Ledda C, Cinà D, Garozzo SF, Senia P, Consoli A, Marconi A, Scialfa V, Nunnari G, Rapisarda V. Tuberculosis screening among healthcare workers in Sicily, Italy. Future Microbiol 2019; 14:37-40. [PMID: 31187655 DOI: 10.2217/fmb-2018-0265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis (TB) is a diffuse communicable disease; and healthcare workers (HCWs) are among the at-risk populations for the disease. This study reports the result of TB surveillance in HCWs operating in three hospitals: one classified as 'low' risk for TB and two as 'medium' risk. A total of 2228 HCWs underwent TB screening using the standard Mantoux technique (also known as the tuberculin sensitivity test [TST]). Interferon-γ release assay (IGRA) was carried out in TST-positive subjects. Results showed an overall positivity of 21% to TST and 2% to IGRA test. TST and IGRA results were statistically associated with HCWs born after 1981. This result is due to university policies that highly recommend TB immunization. Data support the use of IGRA assay in TST-positive HCWs, in order to identify latent TB infection from vaccination.
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Affiliation(s)
- Caterina Ledda
- Occupational Medicine, Department of Clinical & Experimental Medicine, University of Catania, Italy
| | - Diana Cinà
- Clinical Pathology Unit, 'Garibaldi Centro' Hospital, ARNAS Garibaldi, Catania, Italy
| | | | - Paola Senia
- Occupational Medicine, Department of Clinical & Experimental Medicine, University of Catania, Italy
| | - Alessandro Consoli
- Clinical Pathology Unit, 'Garibaldi Centro' Hospital, ARNAS Garibaldi, Catania, Italy
| | - Andrea Marconi
- Occupational Medicine, Department of Clinical & Experimental Medicine, University of Catania, Italy
| | | | - Giuseppe Nunnari
- Infectious Diseases, Department of Clinical & Experimental Medicine, University of Messina, Italy
| | - Venerando Rapisarda
- Occupational Medicine, Department of Clinical & Experimental Medicine, University of Catania, Italy
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Guo LP, Jiang Y, Liu YM, Cao B. First assessment of interferon gamma release assay results among healthcare workers at a general hospital in China. CLINICAL RESPIRATORY JOURNAL 2018; 12:2581-2589. [PMID: 30232836 DOI: 10.1111/crj.12960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 08/12/2018] [Accepted: 09/09/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION China has a very high tuberculosis (TB) burden. The interferon-gamma release assay (IGRA) is more specific for the diagnosis of latent tuberculosis infection (LTBI) than the tuberculin skin test, especially among populations with a high degree of coverage by the BCG vaccine. OBJECTIVES To evaluate the first screening of healthcare workers (HCW) for LTBI using the IGRA at a general hospital in Beijing. METHODS A pilot screening program for LTBI was triggered by accidental contact between HCW and two patients with active TB in the emergency department (ED). Given the necessity of estimating the overall LTBI prevalence in the institution, a sample of 518 HCW was enrolled in our cross-sectional study. The second IGRA was repeated with 43 of the 121 HCW in the ED after exposure to index TB cases. Data on putative risk factors were collected with a self-administered questionnaire. RESULTS The prevalence of LTBI in the targeted population was 21.8%. Differences in the prevalence of LTBI were significantly related to age, employment duration, and history of occupational exposure. A lack of childhood BCG vaccination was independently associated with the prevalence of LTBI (adjusted OR: 1.686, 95% CI: 1.045-2.723, P = .0325). No new LTBI was diagnosed 12 weeks postexposure. No HCW adopted the preventive treatment for LTBI. CONCLUSIONS Considering the high morbidity of LTBI among HCW even in general hospitals, it is essential to formulate government policies and institutional operation protocols for the systematic screening, registration, and administration of prophylaxes for the control of LTBI.
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Affiliation(s)
- Li Ping Guo
- Nosocomial Infection Control Office of China-Japan Friendship Hospital, Beijing, China.,Hospital Management Institute, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Jiang
- Hospital Management Institute, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Mei Liu
- Department of Clinical Microbiology and Infectious Diseases of China-Japan Friendship Hospital, Beijing, China
| | - Bin Cao
- Nosocomial Infection Control Office of China-Japan Friendship Hospital, Beijing, China.,Department of Clinical Microbiology and Infectious Diseases of China-Japan Friendship Hospital, Beijing, China.,National Clinical Research Centre of Respiratory Diseases, Centre for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Department of Pulmonary Medicine, Capital Medical University, Beijing, China
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Jin Y, Wang H, Zhang J, Ding C, Wen K, Fan J, Li T. Prevalence of latent tuberculosis infection among coal workers' pneumoconiosis patients in China: a cross-sectional study. BMC Public Health 2018; 18:473. [PMID: 29642880 PMCID: PMC5896101 DOI: 10.1186/s12889-018-5373-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the prevalence of latent tuberculosis infection (LTBI) among coal workers' pneumoconiosis (CWP) patients. To estimate the prevalence of LTBI and identify its associated risk factors among CWP patients. METHODS A cross-sectional study was conducted to assess the prevalence of LTBI. Participants were screened for active TB or a history of TB by X-ray and those that underwent QuantiFERON-TB Gold In-Tube (QFT) test. A standardized questionnaire was completed and risk factors were assessed for acquiring TB. Log-binomial regression was used to estimate the LTBI prevalence ratio (PR) in relation to risk factors. RESULTS Of 244 individuals with CWP (median age 67 years; all male), 162 (66.4%) were QFT positive. In Multivariate analysis, poor workplace ventilation (adjusted prevalence ratio [APR] = 1.26) and intake of fruits regularly (≥4 days of every week) (APR = 0.81) (all p < 0.05) were associated with a decreased risk of QFT. CONCLUSIONS This study showed a high prevalence of LTBI among individuals with CWP in China. Poor workplace ventilation may be an important contributing factor for LTBI. Regular monitoring and dust control measures need to be improved in workplaces to ensure the safety of workers. Moreover, intake of fruits regularly may be a protective factor for LTBI. However, the effect of fruits should be further studied.
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Affiliation(s)
- Yan Jin
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
- Department of Infectious Disease, Taizhou Center for Disease Control and Prevention, Taizhou, China
| | - Huanqiang Wang
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jianfang Zhang
- Research Center for Occupational Safety and Health, State Administration of Work Safety, Beijing, China
| | - Chunguang Ding
- Research Center for Occupational Safety and Health, State Administration of Work Safety, Beijing, China
| | - Ke Wen
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jingguang Fan
- Research Center for Occupational Safety and Health, State Administration of Work Safety, Beijing, China
| | - Tao Li
- National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
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Yang H, Zhong Y, Wang J, Zhang Q, Li X, Ling S, Wang S, Wang R. Screening of a ScFv Antibody With High Affinity for Application in Human IFN-γ Immunoassay. Front Microbiol 2018; 9:261. [PMID: 29563896 PMCID: PMC5850876 DOI: 10.3389/fmicb.2018.00261] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/02/2018] [Indexed: 12/13/2022] Open
Abstract
Interferon gamma (IFN-γ), a signal proinflammatory cytokine secreted by immune cell, and plays a critical role in the pathogenesis and progression of many diseases. It has been regarded as an important marker for determination of disease-specific immune responses. Therefore, it is urgent to develop a feasible and accurate method to detect IFN-γ in clinic real blood samples. Until now, the immunoassay based on singe chain variable fragment (scFv) antibody for human IFN-γ is still not reported. In the present study, an scFv antibody named scFv-A8 with high specificity was obtained by phage display and biopanning, with the affinity 2.6 × 109 L/mol. Maltose binding protein (MBP) was used to improve the solubility of scFv by inserting an linker DNA between scFv and MBP tag, and the resulted fusion protein (MBP-LK-scFv) has high solubility and antigen biding activity. The expressed and purified MBP-LK-scFv antibody was used to develop the indirect competitive enzyme-linked immunosorbent assay (ELISA) (ic-ELISA) for detection of human IFN-γ, and the result indicated that the linear range to detect IFN-γ was 6–60 pg/mL with IC50 of 25 pg/mL. The limit of detection was 2 pg/mL (1.3 fm), and the average recovery was 85.05%, further demonstrating that the detection method based on scFv has higher recovery and accuracy. Hence, the developed ic-ELISA can be used to detect IFN-γ in real samples, and it may be further provided a scientific basis for disease diagnosis.
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Brüggmann D, Groneberg DA. An index to characterize female career promotion in academic medicine. J Occup Med Toxicol 2017; 12:18. [PMID: 28736572 PMCID: PMC5521076 DOI: 10.1186/s12995-017-0164-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 07/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Imbalances in female career promotion are a key factor of gender disparities at the workplace. They may lead to stress and stress-related diseases including burnout, depression or cardiovascular diseases. Since this problem cannot be generalized and varies between different fields, new approaches are needed to assess and describe the magnitude of the problem in single fields of work. METHODS To construct a new index, operating figures of female and male medical students were collected for Germany in a period over 15 years and their progression throughout their studies towards specialization and academic chair positions. By the use of different female to male ratios (f:m), we constructed an index that describes the extend by which women can ascent in their academic career by using the field of academic medicine as an example. RESULTS A medical student f:m ratio of 1.54 (52,366 female vs. 34,010 male) was found for Germany in 2013. In 1998, this f:m ratio was 0.999. In the same year (2013), the OB/GYN hospital specialists' f:m ratio was 1.566 (3347 female vs. 2137 male physicians) and 0.577 (516 female vs 894 male physicians) for ENT hospital specialists, respectively. The f:m ratios concerning chairs of OB/GYN and ENT were 0.105 and 0.1, respectively. Then an index was generated that incorporated these operating figures with the student f:m ratio as denominator and the chair f:m ratio as numerator while the hospital specialist f:m ratio served as a corrector in the numerator in order to adjust to the attraction of a given field to female physicians. As a result, the index was 0.044 for OB/GYN and 0.113 for ENT instead of ideally ~1 in a completely gender harmonized situation. CONCLUSION In summary, a new index to describe female career advancement was established for academic medicine. By the use of this index, different academic and medical fields can now be compared to each other and future benchmarks could be proposed. Also, country differences may be examined using the proposed index and the success of specific funding programs.
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Affiliation(s)
- Dörthe Brüggmann
- Division of Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
| | - David A Groneberg
- Division of Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt, Germany
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Screening for Tuberculosis in Health Care Workers: Experience in an Italian Teaching Hospital. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7538037. [PMID: 28337457 PMCID: PMC5350285 DOI: 10.1155/2017/7538037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/05/2017] [Accepted: 02/09/2017] [Indexed: 11/26/2022]
Abstract
Health care workers (HCW) are particularly at risk of acquiring tuberculosis (TB), even in countries with low TB incidence. Therefore, TB screening in HCW is a useful prevention strategy in countries with both low and high TB incidence. Tuberculin skin test (TST) is widely used although it suffers of low specificity; on the contrary, the in vitro enzyme immunoassay tests (IGRA) show superior specificity and sensitivity but are more expensive. The present study reports the results of a three-year TB surveillance among HCW in a large teaching hospital in Rome, using TST (by standard Mantoux technique) and IGRA (by QuantiFERON-TB) as first- and second-level screening tests, respectively. Out of 2290 HCW enrolled, 141 (6.1%) had a positive TST; among them, 99 (70.2%) underwent the IGRA and 16 tested positive (16.1%). The frequency of HCW tested positive for TB seems not far from other experiences in low incidence countries. Our results confirm the higher specificity of IGRA, but, due to its higher cost, TST can be considered a good first level screening test, whose positive results should be further confirmed by IGRA before the patients undergo X-ray diagnosis and/or chemotherapy.
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