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Yuan Y, Wang X, Zhou Y, Zhou C, Li S. Prevalence and risk factors of latent tuberculosis infection among college students: a systematic review and meta-analysis. Public Health 2022; 213:135-146. [PMID: 36410119 DOI: 10.1016/j.puhe.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/11/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES College students are at increased risk of tuberculosis (TB), which increases their likelihood of developing latent tuberculosis infections (LTBI). This study aimed to estimate the pooled prevalence of LTBI and identify its risk factors. STUDY DESIGN Systematic review and meta-analysis. METHODS We searched PubMed, Embase, Scopus, Web of Science, CNKI, Wanfang and CBM databases (10 March 2022) for studies published in any language. The pooled prevalence of LTBI was estimated using random effects methods. Factors associated with LTBI were evaluated by determining standardised mean difference (SMD) with 95% confidence interval (CI). All analyses were performed using the Stata 15.1. RESULTS A total of 50 studies from 18 countries were included, with 44 tuberculin skin test (n = 623,732) and 19 interferon gamma release assay (n = 38,266) estimates. The prevalence of a positive tuberculin skin test was 20% (95% CI: 17-23%), and the prevalence of a positive interferon gamma release assay was 9% (95% CI: 7%-11%) among college students. Older age (SMD: 1.67, 95% CI: 1.31-2.13), no Bacillus Calmette-Guérin vaccination/scar (SMD: 1.51, 95% CI: 1.06-2.16), contact with TB cases (SMD: 1.34, 95% CI: 1.11-1.62), clinical training (SMD: 1.93, 95% CI: 1.65-2.26) and overweight/obesity (SMD: 1.17, 95% CI: 1.06-1.30) were associated with a higher prevalence of LTBI. Sex was not associated with LTBI prevalence. CONCLUSION College students have an increased risk of LTBI, although it varies by geographical area. This meta-analysis provides evidence of risk factors for LTBI in college students. Infection control measures should be conducted for college students with LTBI.
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Affiliation(s)
- Yemin Yuan
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xiyuan Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Yanxin Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
| | - Shixue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
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2
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da Silva EH, Lima E, dos Santos TR, Padoveze MC. Prevalence and incidence of tuberculosis in health workers: A systematic review of the literature. Am J Infect Control 2022; 50:820-827. [PMID: 35108578 DOI: 10.1016/j.ajic.2022.01.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To identify the prevalence and incidence of tuberculosis in health workers. METHOD Systematic literature review, according to the protocol of the Joanna Briggs Institute and report following PRISMA guidelines. Primary studies containing data on the incidence or prevalence of active or latent tuberculosis infection in health workers were considered. RESULTS 2,310 potentially relevant studies were identified in ten databases, of which 24 were included. The prevalence of latent tuberculosis varied between 0.1% and 62.0%, and the annual incidence rate varied from 1.4% to 11.4%. A meta-analysis combining data from the studies identified the prevalence as 28% (95% CI 21-36). Occupational risk factors are related to direct contact with patients having active tuberculosis, and more years of professional experience. CONCLUSIONS Evidences show that tuberculosis is an important occupational problem in health care; however, there are still gaps in information about the epidemiology of tuberculosis in health workers, mainly related to the risk factors.
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Apriani L, McAllister S, Sharples K, Aini IN, Nurhasanah H, Ratnaningsih DF, Indrati AR, Ruslami R, Alisjahbana B, van Crevel R, Hill PC. High risk of Mycobacterium tuberculosis infection among medical and nursing students in Indonesia: a 1-year prospective study. Trans R Soc Trop Med Hyg 2021; 116:10-18. [PMID: 33721022 DOI: 10.1093/trstmh/trab038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/03/2021] [Accepted: 02/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Medical and nursing students entering their clinical programmes are at increased risk for tuberculosis (TB) in TB-endemic settings. Relatively little is known about Mycobacterium tuberculosis infection among such students in high-endemic countries. METHODS We examined M. tuberculosis infection among medical and nursing students starting clinical training in Bandung, Indonesia using interferon-γ release assay (IGRA) QuantiFERON-TB Gold Plus. IGRA-negative students had a repeat test after 1 y and logistic regression was used to identify factors associated with IGRA positivity or conversion. RESULTS There were 379 students included in this study: 248 (65.4%) were medical students and 131 (34.6%) were nursing students. Of 379 students, 70 (18.5%) were IGRA positive at baseline. Of 293 IGRA-negative students with 1-y results, 26 (8.9%) underwent IGRA conversion. Being a medical student (adjusted relative risk [ARR] 5.15 [95% confidence interval {CI} 1.82 to 14.59], p=0.002) and participation in sputum collection or bronchoscopy were associated with IGRA conversion (ARR 2.74 [95% CI 1.29 to 5.79], p=0.008). CONCLUSIONS Medical and nursing students entering clinical training are at high risk of M. tuberculosis infection and need improved infection prevention and control strategies.
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Affiliation(s)
- Lika Apriani
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand
| | - Susan McAllister
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand
| | - Katrina Sharples
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand.,Department of Mathematics and Statistics, University of Otago, 730 Cumberland Street, North Dunedin, Dunedin 9016, New Zealand
| | - Isni Nurul Aini
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia
| | - Hanifah Nurhasanah
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia
| | - Dwi Febni Ratnaningsih
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia
| | - Agnes Rengga Indrati
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Jl Pasteur No. 38 Bandung 40161, Indonesia
| | - Rovina Ruslami
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman No. 38 Bandung 40161, Indonesia
| | - Bachti Alisjahbana
- TB Working Group, Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Jl. Prof Eykman, No. 38 Bandung 40161, Indonesia.,Department of Internal Medicine Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Jl Pasteur No. 38 Bandung 40161, Indonesia
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, The Netherlands
| | - Philip C Hill
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 56, Dunedin 9054, New Zealand
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Sangphoo T, Chaiear N, Chanpho P. Work-Related Tuberculosis among Health Workers Employed in a Tertiary Hospital in Northeastern Thailand: A Report of Nine Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145156. [PMID: 32708884 PMCID: PMC7400416 DOI: 10.3390/ijerph17145156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022]
Abstract
Between October 2016 and September 2018, fifteen health workers were diagnosed with tuberculosis (TB) at a tertiary hospital in northeastern Thailand. However, the cases could not be diagnosed as occupational TB according to international standards because of hospital limitations. The use of occupational epidemiological information provides a more effective work-related TB diagnosis. This study aims to provide a report of work-related TB using individual case investigation methods. We collected secondary data from the Occupational Health and Safety Office of the hospital in question, including baseline characteristics for the health workers, occupational history, source of TB infection and occupational exposure, and working environmental measurements. We found that nine of the fifteen cases were diagnosable as work-related TB due to two important factors: daily prolonged exposure time to an infected TB patient, and aerosol-generating procedures without adequate respiratory protection. The other six cases were not diagnosable as work-related TB because of inadequate evidence of activities related to the TB infection. The diagnosis of work-related TB thus requires occupational epidemiological information in order to complete the differentiation process.
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Affiliation(s)
- Thanthun Sangphoo
- Division of Occupational Medicine, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Naesinee Chaiear
- Division of Occupational Medicine, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
- Occupational Health and Safety Office, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
- Correspondence: ; Tel.: +66-4336-3588
| | - Patimaporn Chanpho
- Occupational Health and Safety Office, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
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Apriani L, McAllister S, Sharples K, Alisjahbana B, Ruslami R, Hill PC, Menzies D. Latent tuberculosis infection in healthcare workers in low- and middle-income countries: an updated systematic review. Eur Respir J 2019; 53:13993003.01789-2018. [PMID: 30792341 DOI: 10.1183/13993003.01789-2018] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
Healthcare workers (HCWs) are at increased risk of latent tuberculosis (TB) infection (LTBI) and TB disease.We conducted an updated systematic review of the prevalence and incidence of LTBI in HCWs in low- and middle-income countries (LMICs), associated factors, and infection control practices. We searched MEDLINE, Embase and Web of Science (January 1, 2005-June 20, 2017) for studies published in any language. We obtained pooled estimates using random effects methods and investigated heterogeneity using meta-regression.85 studies (32 630 subjects) were included from 26 LMICs. Prevalence of a positive tuberculin skin test (TST) was 14-98% (mean 49%); prevalence of a positive interferon-γ release assay (IGRA) was 9-86% (mean 39%). Countries with TB incidence ≥300 per 100 000 had the highest prevalence (TST: pooled estimate 55%, 95% CI 41-69%; IGRA: pooled estimate 56%, 95% CI 39-73%). Annual incidence estimated from the TST was 1-38% (mean 17%); annual incidence estimated from the IGRA was 10-30% (mean 18%). The prevalence and incidence of a positive test was associated with years of work, work location, TB contact and job category. Only 15 studies reported on infection control measures in healthcare facilities, with limited implementation.HCWs in LMICs in high TB incidence settings remain at increased risk of acquiring LTBI. There is an urgent need for robust implementation of infection control measures.
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Affiliation(s)
- Lika Apriani
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia .,Dept of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Susan McAllister
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Katrina Sharples
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.,Dept of Mathematics and Statistics, University of Otago, Dunedin, New Zealand
| | - Bachti Alisjahbana
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Dept of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Rovina Ruslami
- TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Dept of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Philip C Hill
- Centre for International Health, Dept of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Dick Menzies
- Montreal Chest Institute, McGill University Montreal, Montreal, QC, Canada
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Keshavarz Valian S, Mahmoudi S, Pourakbari B, Abdolsalehi MR, Eshaghi H, Mamishi S. Screening of healthcare workers for latent tuberculosis infection in the low tuberculosis burden country: QuantiFERON-TB gold in tube test or tuberculin skin test? ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2018; 74:109-114. [PMID: 30516445 DOI: 10.1080/19338244.2017.1394254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/14/2017] [Accepted: 10/14/2017] [Indexed: 06/09/2023]
Abstract
Healthcare workers (HCWs) are an important group at increased risk for exposure to various infectious agents including Mycobacterium tuberculosis. Unfortunately, there is very limited data on the prevalence of latent tuberculosis infection (LTBI) among HCWs in Iran. The aim of this study was to analyze the prevalence of LTBI among HCW's of Children Medical Center (CMC), an Iranian referral hospital, and to compare the feasibility of using tuberculin skin test (TST) and QuantiFERON-TB gold in tube test (QFT-GIT) to screen the LTBI among this population. Informed consent was obtained before the study questionnaire was completed. Participants were then evaluated for LTBI using QFT-GIT test followed immediately by TST. The prevalence of latent TB infection in the 101 HCWs, based on QFT-GIT positivity, was 47% (n = 47), while based on TST test a higher prevalence was observed (n = 57, 57%). Forty-five (45%) subjects were positive for both tests, whereas 14 (14%) were positive by either test. Among the TST positive cases, 21% (n = 12) were negative for QFT-GIT. The overall agreement of TST and QFT-GIT was 86% ([45 + 42]/101] and a moderate correlation between these two tests was observed (Kappa value 0.72). The use of QFT-GIT test as a second step in TST-positive cases offers an appropriate tool for LTBI detection in our country where all HCWs are BCG-vaccinated. To enable the effective control and prevention of TB in healthcare settings in Iran, specific and detailed guidelines for dealing with LTBI are highly required. All newly hired HCWs should receive baseline testing for LTBI before commencing employment. In addition, HCWs who work in high-risk departments should receive regular follow-up screening for LTBI.
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Affiliation(s)
| | - Shima Mahmoudi
- b Pediatric Infectious Disease Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Babak Pourakbari
- b Pediatric Infectious Disease Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Mohammad Reza Abdolsalehi
- c Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Hamid Eshaghi
- c Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Setareh Mamishi
- b Pediatric Infectious Disease Research Center , Tehran University of Medical Sciences , Tehran , Iran
- c Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center , Tehran University of Medical Sciences , Tehran , Iran
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7
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Yeon JH, Seong H, Hur H, Park Y, Kim YA, Park YS, Han CH, Lee SM, Seo JH, Kang JG. Prevalence and risk factors of latent tuberculosis among Korean healthcare workers using whole-blood interferon-γ release assay. Sci Rep 2018; 8:10113. [PMID: 29973678 PMCID: PMC6031657 DOI: 10.1038/s41598-018-28430-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 06/07/2018] [Indexed: 11/15/2022] Open
Abstract
Because healthcare workers (HCWs) are at high risk for tuberculosis (TB) infection, it is essential to research the prevalence of latent TB infection (LTBI) and to implement health interventions including early treatment of LTBI and TB infection control measures. The purpose of the study was to determine the prevalence and risk factors for LTBI using interferon-γ release assay (IGRA) among HCWs in South Korea. The cross-sectional study was carried in the National Health Insurance Service Ilsan Hospital, which is a 740-bed general hospital, South Korea. HCWs who participated in this survey were required to complete a questionnaire and IGRA was performed. Of the 1,655 HCWs, 271 results were positive and the prevalence of LTBI was 16% (95% CI; 15–18%). In the multivariate analysis, age (OR; 2.201, 95% CI; 1.911–2.536, P < 0.001), male sex (OR; 1.523, 95% CI; 1.133–2.046, P = 0.005), contact active TB patients (OR; 1.461, 95% CI; 1.061–2.010, P = 0.02) and diabetes (OR; 2.837, 95% CI; 1.001–8.044, P = 0.05) were significant risk factors for LTBI. LTBI among HCWs in Korea, although prevalent, might not exceed the background level of the general population. Because contact with active TB patients has been identified as a risk factor for LTBI, more effective TB infection control measures are essential in healthcare facilities and congregate settings.
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Affiliation(s)
- Jeong Hwa Yeon
- Infection Control Unit, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Hye Seong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho Hur
- Infection Control Unit, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Yoonseon Park
- Infection Control Unit, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Young Ah Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Yoon Soo Park
- Infection Control Unit, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea. .,Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
| | - Chang Hoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Sun Min Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jeong Hun Seo
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jung Gu Kang
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.
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Manana PN, Kuonza L, Musekiwa A, Koornhof H, Nanoo A, Ismail N. Feasibility of using postal and web-based surveys to estimate the prevalence of tuberculosis among health care workers in South Africa. PLoS One 2018; 13:e0197022. [PMID: 29746507 PMCID: PMC5945004 DOI: 10.1371/journal.pone.0197022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 04/25/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Health Care Workers (HCWs) are among the highest risk groups for contracting tuberculosis (TB), which is ranked the third most common occupational health disease in South Africa. Little is known about the true extent of the burden of TB among South African HCWs and current surveillance approaches are inadequate. The study aimed to determine the feasibility of using postal and web-based surveys accessed through registries of registered professionals to estimate the prevalence of TB among HCWs in South Africa. MATERIALS AND METHODS We conducted a cross sectional survey on a sample of professional nurses and doctors (general practitioners) registered on the Medpages database platform; a subscription based registry for practising health care professionals. The survey included professionals who were actively involved in the clinical management of patients, either in public or private health care facilities. The paper based survey, including pre-paid return envelopes, was distributed via the post office and web-based surveys were distributed via e-mail through a hyperlink. Descriptive statistics were used to summarize the data and the Chi-square test to determine associations between categorical variables. Active TB was defined as any history of TB. RESULTS Out of a total of 3,400 health care professionals contacted, 596 (18%) responses were received: 401 (67%) web-based and 195 (33%) postal. A significantly higher percentage of complete forms were from postal compared to web-based (97% [189/195] versus 87% [348/401], p<0.001). Younger (<60 years) professionals were more likely to use the web-based compared to postal (87% [236/270] versus 71% [134/189], p<0.001). Overall, the prevalence of active TB infection was 8.7%, (95%CI: 6.3%-11.7%) and there was no difference observed between doctors and nurses (10.8% [18/167] versus 7.5% [22/292], p = 0.236). CONCLUSION This novel approach demonstrated the feasibility of using an existing registry of professionals to conduct surveys to estimate the prevalence of TB. Our findings showed a high TB prevalence; however the estimate might have been biased by the low response rate. Further research to optimise our approach could lead to a viable option in improving surveillance among health care professionals.
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Affiliation(s)
- Pinky N. Manana
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- * E-mail:
| | - Lazarus Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Alfred Musekiwa
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Hendrik Koornhof
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ananta Nanoo
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Nazir Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa
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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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10
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Park JS. The Prevalence and Risk Factors of Latent Tuberculosis Infection among Health Care Workers Working in a Tertiary Hospital in South Korea. Tuberc Respir Dis (Seoul) 2018; 81:274-280. [PMID: 30238715 PMCID: PMC6148103 DOI: 10.4046/trd.2018.0020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/04/2018] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background The risk of tuberculosis (TB) infection among health care workers (HCWs) is higher than as noted among workers in the general population. The prevalence and risk factors of TB infection among HCWs were assessed in a tertiary hospital in South Korea, resulting in a conclusion of an intermediate TB burden within the country. Methods This cross-sectional study enrolled HCWs who underwent a QuantiFERON-TB Gold In-Tube (QFT-GIT) test to detect the presence of a latent TB infection (LTBI), in patients admitted to a tertiary hospital in South Korea in 2017. The departments of the hospital were divided into TB-related and TB-unrelated departments, which were based on the risk of exposure to TB patients. In this sense, the risk factors for LTBI, including current working in the TB-related departments, were analyzed. Results In this case, a total of 499 HCWs (54 doctors, 365 nurses and 80 paramedical personnel) were enrolled in this study. The median age of the subjects was 31 years (range, 20–67 years), 428 (85.8%) were female, and 208 (41.7%) were working in the TB-related departments. The prevalence of LTBI was 15.8% based on the QFT-GIT. Additionally, the prevalence of experience of exposure to pre-treatment TB patents was higher among HCWs working in the TB-related departments, than among HCWs working in the TB-unrelated departments (78.8% vs. 61.9%, p<0.001). However, there was no significant difference in the prevalence of LTBI between the two groups (17.3% vs. 14.8%, p=0.458). On a review of the multivariate analysis, only the factor of age was independently associated with an increased risk of LTBI (p=0.006). Conclusion Broadly speaking, the factor of age was associated with an increased risk of LTBI among the HCWs in South Korea. However, those workers current working in the TB-related departments was not associated with an increased risk of LTBI.
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Affiliation(s)
- Jae Seuk Park
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
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Prado TND, Riley LW, Sanchez M, Fregona G, Nóbrega RLP, Possuelo LG, Zandonade E, Locatelli RL, Souza FMD, Rajan JV, Maciel ELN. Prevalence and risk factors for latent tuberculosis infection among primary health care workers in Brazil. CAD SAUDE PUBLICA 2017; 33:e00154916. [PMID: 29267691 DOI: 10.1590/0102-311x00154916] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 04/03/2017] [Indexed: 02/06/2023] Open
Abstract
Health care workers (HCW) are at increased risk of latent tuberculosis infection (LTBI) from occupational exposure to Mycobacterium tuberculosis. The objective was to determine the prevalence of and risk factors for LTBI among primary HCW in five Brazilian cities. We conducted a cross-sectional study, from 2011 to 2013, among primary HCW, using a structured questionnaire and an evaluated for LTBI using the Quantiferon-TB Gold in-tube test. The magnitude of the associations was assessed using hierarchical logistic regression models. Among 708 HCW, the LTBI prevalence was 27% (n = 196; 95%CI: 24%-31%). We found that the following factors were positively associated with LTBI in primary HCW: age > 50 years (OR = 2.94; 95%CI: 1.44-5.99), absence of a BCG scar (OR = 2.10; 95%CI: 1.28-3.43), self-reported ex-smoker status (OR = 1.80; 95%CI: 1.04-3.11), being a nurse (OR = 2.97; 95%CI: 1.13-7.83), being a nurse technician (OR = 3.10; 95%CI: 1.26-7.60), being a community health agent (OR = 2.60; 95%CI: 1.06-6.40), and irregular use of N95 masks (OR = 2.51; 95%CI: 1.11-5.98). In contrast, HCWs who do not work in health care facilities with a TB control program were less likely to have LTBI (OR = 0.66; 95%CI: 0.45-0.97). This study demonstrated a substantial occupational risk of LTBI among primary HCW in Brazil. The Brazilian TB control program, as well as local programs, need to target these high-risk HCW with education, as well as with better personal protective equipment to prevent acquisition of new TB infection.
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Affiliation(s)
| | - Lee W Riley
- School of Public Health, University of California, Berkeley, U.S.A
| | | | - Geisa Fregona
- Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brasil.,Hospital Universitário Cassiano Antonio Moraes, Universidade Federal do Espírito Santo, Vitória, Brasil
| | | | | | - Eliana Zandonade
- Departamento de Estatística, Universidade Federal do Espírito Santo, Vitória, Brasil
| | - Rodrigo Leite Locatelli
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória, Brasil
| | | | - Jayant V Rajan
- School of Medicine, University of California, San Francisco, U.S.A
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Uden L, Barber E, Ford N, Cooke GS. Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis. Open Forum Infect Dis 2017; 4:ofx137. [PMID: 28875155 PMCID: PMC5575844 DOI: 10.1093/ofid/ofx137] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/24/2017] [Indexed: 01/25/2023] Open
Abstract
Background Tuberculosis (TB) remains a major challenge to global health. Healthcare workers (HCWs) appear to be at increased risk of TB compared with the general population, despite efforts to scale up infection control and reduce nosocomial TB transmission. This review aims to provide an updated estimate of the occupational risk of latent TB infection (LTBI) and active TB among HCWs compared with the general population. Methods A systematic review was performed to identify studies published over the last 10 years reporting TB prevalence or incidence among HCWs and a control group. Pooled effect estimates were calculated to determine the risk of infection. Results Twenty-one studies met the inclusion criteria, providing data on 30961 HCWs across 16 countries. Prevalence of LTBI among HCWs was 37%, and mean incidence rate of active TB was 97/100000 per year. Compared with the general population, the risk of LTBI was greater for HCWs (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.61–3.20), and the incidence rate ratio for active TB was 2.94 (95% CI, 1.67–5.19). Comparing tuberculin skin test and interferon-gamma release assay, OR for LTBI was found to be 1.72 and 5.61, respectively. Conclusions The overall risk of both LTBI and TB to HCWs continues to be significantly higher than that of the general population, consistent with previous findings. This study highlights the continuing need for improvements in infection control and HCW screening programs.
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Affiliation(s)
- Lydia Uden
- Division of Infectious Diseases, Imperial College London
| | - Ella Barber
- Division of Infectious Diseases, Imperial College London.,Manson Unit, Médecins Sans Frontières, London, UK; and
| | - Nathan Ford
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
| | - Graham S Cooke
- Division of Infectious Diseases, Imperial College London
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Hefzy EM, Wegdan AA, Elhefny RA, Nasser SH. Predictors of low prevalence of latent tuberculosis infection among Egyptian health care workers at intensive care and bronchoscopy units. GMS HYGIENE AND INFECTION CONTROL 2016; 11:Doc22. [PMID: 27777875 PMCID: PMC5062057 DOI: 10.3205/dgkh000282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim: Latent tuberculosis infections (LTBI) contain a significant reservoir for future epidemics. Screening of health care workers (HCWs) in a high-risk tuberculosis (TB) environment is an important strategy in TB control. The study aimed to assess the prevalence of LTBI among high risk Egyptian HCWs and to assess infection associated risk factors. Methods: Fifty-two HCWs who work at intensive care unit (ICU), bronchoscopy unit, and chest diseases department were tested for LTBI using both tuberculin skin test (TST) and Quantiferon TB Gold in-tube test (QFT). Risk factors for infection, knowledge of HCWs towards different aspects of TB infection and agreement between TST and QFT were also evaluated. Results: Prevalence of LTBI in this study was 13.5% by QFT and TST. It was 13.6% by TST alone and 10.3% by QFT alone. There was good concordance between both tests (Kappa=0.713). There was a statistically significant association between prevalence of LTBI and age of staff ≥30 yr (p=0.002), period of working experience (p=0.006) and working at the Bronchoscopy Unit (p=0.001). The total knowledge of HCWs towards different aspects of TB infection was generally good. Conclusion: Although the participants in the current study were among high risk HCWs, the prevalence of LTBI was low. Bacille Calmette-Guerin (BCG) vaccination, young age, short employment duration, good knowledge and a good infection control were the predictors of low risk of contracting TB at our hospitals. The risk of TB infection in resource-limited countries can be reduced with simple continuous educational and administrative infection control programmes.
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Affiliation(s)
- Enas Mamdouh Hefzy
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Ahmed Ashraf Wegdan
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Radwa Ahmed Elhefny
- Department of Chest Diseases, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Du F, Zhang Z, Gao T, Liu Z, Jia H, Xing A, Du B, Sun Q, Cao T, Zhang Z. Diagnosis of latent tuberculosis by ELISPOT assay and tuberculin skin test. Med Mal Infect 2016; 46:150-3. [PMID: 27021933 DOI: 10.1016/j.medmal.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the prevalence of latent tuberculosis infection (LTBI) in college students. PATIENTS AND METHODS Four hundred and twenty newly admitted college students were enrolled. The Enzyme-Linked ImmunoSpot assay (ELISPOT) was used. Overall, 171 students with ELISPOT assay+/TST+ were monitored for three years to detect active TB disease. RESULTS The overall positive rate of ELISPOT assay was 40.7% among TST+ students. The ELISPOT positive rates were 36.9%, 45.4%, and 64.3% in groups of TST induration of 10-14mm, 15-20mm, and ≥20mm, respectively, with a significant difference (χ(2)=10.136, P<0.01) but no significant difference between BCG scar and no scar (41.2% vs. 38.8%; P>0.05). None of the 171 untreated students contracted active TB within the three-year monitoring period. CONCLUSION The LTBI rate might be overestimated by TST compared with interferon-γ release assays. On the basis of a close monitoring, few students developed active TB despite a positive result to the TST and ELISPOT assay.
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Affiliation(s)
- F Du
- Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, 101149 Beijing, China
| | - Z Zhang
- Changping Tuberculosis Prevent and Control Institute of Beijing, 102206 Beijing, China
| | - T Gao
- Changping Tuberculosis Prevent and Control Institute of Beijing, 102206 Beijing, China
| | - Z Liu
- Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, 101149 Beijing, China
| | - H Jia
- Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, 101149 Beijing, China
| | - A Xing
- Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, 101149 Beijing, China
| | - B Du
- Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, 101149 Beijing, China
| | - Q Sun
- Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, 101149 Beijing, China
| | - T Cao
- Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, 101149 Beijing, China
| | - Z Zhang
- Beijing Key Laboratory for Drug Resistant Tuberculosis Research, Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, 101149 Beijing, China.
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Hibah NAA, Hasan HEA. Prevalence of latent tuberculosis infection among multinational healthcare workers in Muhayil Saudi Arabia. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2015. [DOI: 10.4103/1687-8426.158078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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He G, Li Y, Zhao F, Wang L, Cheng S, Guo H, Klena JD, Fan H, Gao F, Gao F, Han G, Ren L, Song Y, Xiong Y, Geng M, Hou Y, He G, Li J, Guo S, Yang J, Yan D, Wang Y, Gao H, An J, Duan X, Wu C, Duan F, Hu D, Lu K, Zhao Y, Rao CY, Wang Y. The Prevalence and Incidence of Latent Tuberculosis Infection and Its Associated Factors among Village Doctors in China. PLoS One 2015; 10:e0124097. [PMID: 25996960 PMCID: PMC4440671 DOI: 10.1371/journal.pone.0124097] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 02/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background China is a high tuberculosis (TB) burden country. More than half of acute TB cases first seek medical care in village doctors’ clinics or community health centers. Despite being responsible for patient referral and management, village doctors are not systematically evaluated for TB infection or disease. We assessed prevalence and incidence of latent TB infection (LTBI) among village doctors in China. Methods and Findings A longitudinal study was conducted in Inner Mongolia Autonomous Region. We administered a questionnaire on demographics and risk factors for TB exposure and disease; Tuberculin skin testing (TST) and QuantiFERON-TB Gold in-tube assay (QFT-GIT) was conducted at baseline and repeated 12 months later. We used a logistic regression model to calculate adjusted odds ratios (ORs) for risk factors for TST and QFT-GIT prevalence and incidence. At the time of follow up, 19.5% of the 880 participating village doctors had a positive TST and 46.0% had a positive QFT-GIT result. Factors associated with TST prevalence included having a BCG scar (OR = 1.45, 95%CI 1.03–2.04) and smoking (OR = 1.69, 95%CI 1.17–2.44). Risk factors associated with QFT-GIT prevalence included being male (OR = 2.17, 95%CI 1.63–2.89), below college education (OR=1.42, 95%CI 1.01–1.97), and working for ≥25 years as a village doctor (OR = 1.64, 95%CI 1.12–2.39). The annual incidence of LTBI was 11.4% by TST and 19.1% by QFT-GIT. QFT-GIT conversion was associated with spending 15 minutes or more per patient on average (OR = 2.62, 95%CI 1.39–4.97) and having BCG scar (OR = 0.53, 95%CI 0.28–1.00). Conclusions Prevalence and incidence of LTBI among Chinese village doctors is high. TB infection control measures should be strengthened among village doctors and at village healthcare settings.
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Affiliation(s)
- Guangxue He
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Li
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America
| | - Fei Zhao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lixia Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiming Cheng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Guo
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - John D. Klena
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America
| | - Haiying Fan
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fangfang Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Fei Gao
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Guoxin Han
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Liping Ren
- Inner Mongolia Center for Tuberculosis Control and Prevention, Hohhot, China
| | - Yudan Song
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongchao Xiong
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mengjie Geng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yueyun Hou
- The Tongzhou Maternal & Child Health Hospital, Beijing, China
| | - Guoming He
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Jianbo Li
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Shufang Guo
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Jun Yang
- Ulanqab Center for Tuberculosis Control and Prevention, Jining, China
| | - Daiqin Yan
- the Bayannur for Tuberculosis Control and Prevention, Bayannur, China
| | - Yali Wang
- the Bayannur for Tuberculosis Control and Prevention, Bayannur, China
| | - Haiyan Gao
- the Bayannur for Tuberculosis Control and Prevention, Bayannur, China
| | - Jing An
- Linhe District Center for Disease Control and Prevention, Bayannur, China
| | - Xiaoyan Duan
- Linhe District Center for Disease Control and Prevention, Bayannur, China
| | - Chunru Wu
- Hanggin Rear Banner Center for Disease Control and Prevention, Bayannur, China
| | - Fengming Duan
- Hanggin Rear Banner Center for Disease Control and Prevention, Bayannur, China
| | - Dongmei Hu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kai Lu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanlin Zhao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Carol Y. Rao
- Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, United States Centers for Disease Control and Prevention Atlanta, Georgia, United States of America
- * E-mail: (YW); (CYR)
| | - Yu Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (YW); (CYR)
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Rutanga C, Lowrance DW, Oeltmann JE, Mutembayire G, Willis M, Uwizeye CB, Hinda R, Bassirou C, Gutreuter S, Gasana M. Latent Tuberculosis Infection and Associated Factors among Health Care Workers in Kigali, Rwanda. PLoS One 2015; 10:e0124485. [PMID: 25919759 PMCID: PMC4412475 DOI: 10.1371/journal.pone.0124485] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/03/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Data are limited regarding tuberculosis (TB) and latent TB infection prevalence in Rwandan health facilities. METHODS We conducted a cross-sectional survey among healthcare workers (HCWs) in Kigali during 2010. We purposively selected the public referral hospital, both district hospitals, and randomly selected 7 of 17 health centers. School workers (SWs) from the nearest willing public schools served as a local reference group. We tested for latent TB infection (LTBI) using tuberculin skin testing (TST) and asked about past TB disease. We assessed risk of LTBI and past history of TB disease associated with hospital employment. Among HCWs, we assessed risk associated with facility type (district hospital, referral hospital, health center), work setting (inpatient, outpatient), and occupation. RESULTS Age, gender, and HIV status was similar between the enrolled 1,131 HCWs and 381 SWs. LTBI was more prevalent among HCWs (62%) than SWs (39%). Adjusted odds of a positive TST result were 2.71 (95% CI 2.01-3.67) times greater among HCWs than SWs. Among HCWs, there was no detectable difference between prevalence of LTBI according to facility type, work setting, or occupation. CONCLUSION HCWs are at greater risk of LTBI, regardless of facility type, work setting, or occupation. The current status of TB infection control practices should be evaluated in the entire workforce in all Rwandan healthcare facilities.
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Affiliation(s)
- Claude Rutanga
- Division of Tuberculosis and Other Respiratory Communicable Diseases Rwanda Biomedical Centre, Kigali, Rwanda
- * E-mail:
| | - David W. Lowrance
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - John E. Oeltmann
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Grace Mutembayire
- Division of Tuberculosis and Other Respiratory Communicable Diseases Rwanda Biomedical Centre, Kigali, Rwanda
| | - Matt Willis
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, United States of America
| | | | - Ruton Hinda
- Division of HIV-AIDS, Sexually Transmitted Infections, and Other Blood Borne Diseases, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Chitou Bassirou
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Steve Gutreuter
- Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Michel Gasana
- Division of Tuberculosis and Other Respiratory Communicable Diseases Rwanda Biomedical Centre, Kigali, Rwanda
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Al-Darraji HAA, Tan C, Kamarulzaman A, Altice FL. Prevalence and correlates of latent tuberculosis infection among employees of a high security prison in Malaysia. Occup Environ Med 2015; 72:442-7. [PMID: 25794506 DOI: 10.1136/oemed-2014-102695] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Although prison employees share the same tuberculosis (TB) risk environment with prisoners, the magnitude of TB problems among prison employees is unknown in most resource-limited prisons. This survey was conducted to investigate the prevalence and correlates of tuberculin skin test (TST) positivity among employees in Malaysia's largest prison. METHODS Consented, full-time prison employees were interviewed using a structured questionnaire that included sociodemographic data, history of working in the correctional system and TB-related risk. TST was placed intradermally and read after 48-72 h. Induration size of ≥10 mm was considered positive. Logistic regression analyses were conducted to explore associations with TST positivity. RESULTS Of the 445 recruited prison employees, 420 (94.4%) had complete data. Most were young (median=30.0 years) men (88.8%) who had only worked at this prison (76.4%) for a median total employment period of 60 months (IQR 34.5-132.0). The majority were correctional officers, while civilian employees represented only 7.6% of the sample. Only 26 (6.2%) reported having ever been screened for TB since employment. Prevalence of TST positivity was 81% and was independently associated with longer (≥12 months) prison employment (AOR 4.9; 95% CI 1.5 to 15.9) and current tobacco smoking (AOR=1.9, 95% CI 1.2 to 3.2). CONCLUSIONS Latent TB prevalence was high in this sample, approximating that of prisoners in this setting, perhaps suggesting within prison TB transmission in this facility. Formal TB control programmes for personnel and prisoners alike are urgently needed within the Malaysian correctional system.
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Affiliation(s)
| | - Cynthia Tan
- University of Melbourne, Melbourne, Australia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Frederick L Altice
- Centre of Excellence for Research in AIDS, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, Connecticut, USA Division of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
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Impact of Routine Quantiferon Testing on Latent Tuberculosis Diagnosis and Treatment in Refugees in Multnomah County, Oregon, November 2009–October 2012. J Immigr Minor Health 2015; 18:292-300. [DOI: 10.1007/s10903-015-0187-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adams S, Ehrlich R, Baatjies R, van Zyl-Smit RN, Said-Hartley Q, Dawson R, Dheda K. Incidence of occupational latent tuberculosis infection in South African healthcare workers. Eur Respir J 2015; 45:1364-73. [PMID: 25700382 DOI: 10.1183/09031936.00138414] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/09/2014] [Indexed: 11/05/2022]
Abstract
The test-specific incidence of latent tuberculosis infection (LTBI) in healthcare workers from sub-Saharan Africa is unknown. 505 healthcare workers from South Africa were screened at baseline, and after 12 months, with a questionnaire, the tuberculin skin test (TST), and two T-cell assays (T-SPOT.TB and QuantiFERON-TB Gold-In-Tube). Test-specific conversion rates were calculated. The prevalence of presumed LTBI at baseline was 84, 69 and 62% using the TST, QuantiFERON-TB Gold-In-Tube and T-SPOT.TB, respectively. The annual test-specific conversion rate, depending on the cut-off point used, was as follows: TST 38%; QuantiFERON-TB Gold-In-Tube 13-22%; and T-SPOT.TB 18-22%. Annual reversion rates were 4, 7 and 16%, respectively. The annual TST conversion rate was significantly higher than that derived from published local community-based data (IRR 3.53, 95% CI 1.81-6.88). Factors associated with conversion (any test) included healthcare sector of employment, counselling of tuberculosis patients, and a baseline positive TST (for T-SPOT.TB). The annual rate of tuberculosis infection in South African healthcare workers was very high, irrespective of the testing method used, and may be explained by occupational exposure, as the rate was considerably higher than non-healthcare workers from the same community. Collectively, these data support the need for implementation of tuberculosis-specific infection control measures in Africa.
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Affiliation(s)
- Shahieda Adams
- Lung Infection and Immunity Unit, Dept of Medicine, University of Cape Town, Cape Town, South Africa Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rodney Ehrlich
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Roslynn Baatjies
- Dept of Environmental and Occupational Studies, Faculty of Applied Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Richard N van Zyl-Smit
- Lung Infection and Immunity Unit, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Rodney Dawson
- Centre for TB Research Innovation, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Dept of Medicine, University of Cape Town, Cape Town, South Africa
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Interferon-γ Release Assay vs. Tuberculin Skin Test for Tuberculosis Screening in Exposed Healthcare Workers: A Longitudinal Multicenter Comparative Study. Infect Control Hosp Epidemiol 2015; 36:569-74. [DOI: 10.1017/ice.2015.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEHealthcare workers (HCWs), especially those caring for patients with tuberculosis (TB), are at high risk of acquiring that disease. The poor specificity of tuberculin skin testing (TST) prompted us to evaluate the effectiveness of the interferon-γ release assay (IGRA) in comparison with TST in a large prospective, multicenter, 1-year study of HCWs with occupational exposure to TB.METHODSHCWs from high-risk units at 14 university hospitals were invited to participate and underwent both TST and IGRA (first Quantiferon TB Gold-IT®, QFT-G, then T-SPOT.TB® if QFT-G was indeterminate) at baseline and after 1 year. We collected demographic characteristics, country of birth, history of TB, immunosuppression, past exposure to TB, history of BCG vaccination, results of most recent TST, job category, and duration of current function.RESULTSAmong 807 HCWs enrolled, current or past TST at baseline was positive (≥15 mm) in 282 (34.9%); the IGRA was positive in 113 (14.0%) and indeterminate in 3 (0.4%). After 1 year, 594 HCWs had both an IGRA and TST (or prior TST≥15 mm) at baseline and an IGRA and TST (if indicated). The conversion rate was 2.5% (9 of 367) with TST and 7.6% (45 of 594) with IGRA, with poor agreement between the 2 tests. Using only QFT-G, conversion (9.9%) and reversion (17.8%) rates were higher for baseline QFT-G positive quantitative values <1 IU/mL.CONCLUSIONTST and the IGRA yielded discordant results. The value of IGRA in addition to TST remains undetermined; the two should be jointly interpreted in decision-making (clinical trial registration NCT00797836).Infect Control Hosp Epidemiol 2015;00(0): 1–6
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Khanna P, Nikolayevskyy V, Warburton F, Dobson E, Drobniewski F. Rate of Latent Tuberculosis Infection Detected by Occupational Health Screening of Nurses New to a London Teaching Hospital. Infect Control Hosp Epidemiol 2015; 30:581-4. [DOI: 10.1086/597546] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The prevalence of latent tuberculosis infection in a cohort of nurses new to a London hospital was 7.6% (13 of 171), using an interferon-γ(IFN-γ) release assay, and 16.2% (24 of 148), using the tuberculin skin test. On multivariate analysis, birth in a country with tuberculosis prevalence of more than 40 cases per 100,000 population was associated with positive results of both the IFN-γ release assay and the tuberculin skin test.
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Gorman T, Dropkin J, Kamen J, Nimbalkar S, Zuckerman N, Lowe T, Szeinuk J, Milek D, Piligian G, Freund A. Controlling health hazards to hospital workers. New Solut 2014; 23 Suppl:1-167. [PMID: 24252641 DOI: 10.2190/ns.23.suppl] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Zellweger JP, Rieder HL. Serial screening for latent tuberculosis infection in healthcare workers in low-risk settings. Am J Respir Crit Care Med 2014; 189:3-4. [PMID: 24381985 DOI: 10.1164/rccm.201311-2062ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mukuku O, Ruhindiza BM, Mupepe AK, Sawadogo M. [TB among health personnel of the public sector in Burundi: frequency and risk factors]. Pan Afr Med J 2013; 16:140. [PMID: 24847402 PMCID: PMC4024431 DOI: 10.11604/pamj.2013.16.140.3209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 11/30/2013] [Indexed: 02/05/2023] Open
Abstract
Introduction Le but de cette étude était de déterminer la fréquence de la tuberculose (TB) chez le personnel de santé du secteur public en charge des patients tuberculeux et d’évaluer les facteurs de risque de contracter la tuberculose chez ce personnel au Burundi. Méthodes Il s’agit d’une étude transversale à visée analytique réalisée auprès de 300 travailleurs prestant dans 30 centres de dépistage et de traitement de la TB (CDT) au Burundi du 16 octobre au 15 novembre 2012. Les paramètres sociodémographiques et professionnels ainsi que l’antécédent de vaccination BCG de travailleurs ayant été touché par la TB ont été analysé et comparé à ceux de travailleurs qui ne l’ont pas été. Le seuil de signification a été fixé à p < 0,05. Résultats La fréquence de la TB chez le personnel de santé est de 15%. Le risque de souffrir de la TB est de près de 4 fois chez les travailleurs âgés d’au moins 50 ans (OR=3,73; 1,53-9,08), chez ceux qui n’ont jamais reçu de vaccin de BCG (OR=3,73; 1,24-11,03), chez ceux qui n’ont pas de cicatrice vaccinale de BCG (OR=3,80; 1,67-8,62) et chez ceux qui travaillent depuis au moins 6 ans dans un CDT (OR=3,79; 1,44-9,96); ce risque est de 9 fois chez ceux qui sont mariés (OR=9,42; 1,26-70,23), de 8 fois chez ceux qui n’aèrent pas leurs salles de travail (OR=8,20; 1,48-48,23) et de 6 fois chez ceux qui ont comme profession nettoyeur ou aide-soignant (OR=6,12; 2,92-12,82). Par contre, aucune corrélation statistiquement significative n’a été observée entre le fait de souffrir de la TB et le sexe mais aussi le nombre d’heures de contact d’un travailleur avec un patient tuberculeux (p>0,05). Conclusion L’âge, l’antécédent de vaccination de BCG ainsi que la majorité de paramètres professionnels sont en association avec la maladie TB des travailleurs de CDT. D’où, la maîtrise de certains facteurs de risque s’avère important pour faire face au fardeau de la TB parmi le personnel hospitalier.
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Affiliation(s)
- Olivier Mukuku
- Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | | | - Alexis Kumba Mupepe
- Institut Supérieur des Techniques Médicales d'Uvira, République Démocratique du Congo
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Durando P, Sotgiu G, Spigno F, Piccinini M, Mazzarello G, Viscoli C, Copello F, Poli A, Ansaldi F, Icardi G. Latent tuberculosis infection and associated risk factors among undergraduate healthcare students in Italy: a cross-sectional study. BMC Infect Dis 2013; 13:443. [PMID: 24059355 PMCID: PMC3848912 DOI: 10.1186/1471-2334-13-443] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 09/18/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The screening of both healthcare workers and students attending teaching hospitals for latent tuberculosis infection (LTBI) is recommended in hospitals of many countries with a low-incidence of TB, including Italy, as a fundamental tool of tuberculosis (TB) control programs. The aim of the study was to estimate the prevalence of LTBI and evaluate the main risk-factors associated with this condition in a cohort of healthcare Italian students. METHODS In a cross-sectional study, performed between January and May 2012, 881 undergraduate students attending the Medical, Nursing, Pediatric Nursing and Midwifery Schools of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the Tuberculin Skin Test (TST). All the TST positive cases were also tested with an Interferon-Gamma Release Assay (IGRA) to confirm the diagnosis of LTBI. A standardized questionnaire was collected for risk-assessment analysis. RESULTS Seven hundred and thirty-three (83.2%) subjects underwent TST testing. The prevalence of TST positives was 1.4%, and in 4 (0.5%) out of 10 TST positive cases LTBI diagnosis was confirmed by IGRA. No difference in the prevalence of subjects who tested positive to TST emerged between pre-clinical (n = 138) and clinical (n = 595) students. No statistically significant association between TST positivity and age, gender, and BCG vaccination was observed. The main independent variable associated with TST positivity was to be born in a country with a high TB incidence (i.e., ≥20 cases per 100,000 population) (adjusted OR 102.80, 95% CI 18.09-584.04, p < 0.001). CONCLUSIONS The prevalence of LTBI among healthcare students resulted very low. The only significant association between TST positivity and potential risk factors was to be born in high TB incidence areas. In countries with a low incidence of TB, the screening programs of healthcare students before clinical training can be useful for the early identification and treatment of the sporadic cases of LTBI.
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Affiliation(s)
- Paolo Durando
- Department of Health Sciences, Associate Professor of Hygiene, Preventive Medicine and Public Health, Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
| | - Giovanni Sotgiu
- Department of Biomedical Sciences, Associate Professor of Medical Statistics, Research, Medical Education and Professional Development Unit, AOU Sassari, University of Sassari, Via Padre Manzella 4, 07100, Sassari, Italy
| | - Fabio Spigno
- Department of Health Sciences, Associate Professor of Occupational Health, Chief of the Occupational Health Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Mauro Piccinini
- Prevention and Protection Service of the University of Genoa, Via Balbi 5, 16126, Genoa, Italy
| | - Giovanni Mazzarello
- Department of Health Sciences, Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Claudio Viscoli
- Department of Health Sciences, Full Professor of Infectious Diseases, Chief of the Infectious Diseases Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Francesco Copello
- Occupational and Preventive Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Alessandro Poli
- Occupational and Preventive Medicine Unit, IRCCS AOU San Martino-IST teaching Hospital, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Filippo Ansaldi
- Department of Health Sciences, Associate Professor of Hygiene, Preventive Medicine and Public Health, Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, Full Professor of Hygiene, Preventive Medicine and Public Health, Chief of the Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
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Drobniewski F, Nikolayevskyy V, Maxeiner H, Balabanova Y, Casali N, Kontsevaya I, Ignatyeva O. Rapid diagnostics of tuberculosis and drug resistance in the industrialized world: clinical and public health benefits and barriers to implementation. BMC Med 2013; 11:190. [PMID: 23987891 PMCID: PMC3765611 DOI: 10.1186/1741-7015-11-190] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/02/2013] [Indexed: 02/06/2023] Open
Abstract
In this article, we give an overview of new technologies for the diagnosis of tuberculosis (TB) and drug resistance, consider their advantages over existing methodologies, broad issues of cost, cost-effectiveness and programmatic implementation, and their clinical as well as public health impact, focusing on the industrialized world. Molecular nucleic-acid amplification diagnostic systems have high specificity for TB diagnosis (and rifampicin resistance) but sensitivity for TB detection is more variable. Nevertheless, it is possible to diagnose TB and rifampicin resistance within a day and commercial automated systems make this possible with minimal training. Although studies are limited, these systems appear to be cost-effective. Most of these tools are of value clinically and for public health use. For example, whole genome sequencing of Mycobacterium tuberculosis offers a powerful new approach to the identification of drug resistance and to map transmission at a community and population level.
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Affiliation(s)
- Francis Drobniewski
- Public Health England National Mycobacterium Reference Laboratory, 2 Newark Street, London E1 2AT, UK.
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Jo KW, Hong Y, Park JS, Bae IG, Eom JS, Lee SR, Cho OH, Choo EJ, Heo JY, Woo JH, Shim TS. Prevalence of Latent Tuberculosis Infection among Health Care Workers in South Korea: A Multicenter Study. Tuberc Respir Dis (Seoul) 2013; 75:18-24. [PMID: 23946754 PMCID: PMC3741469 DOI: 10.4046/trd.2013.75.1.18] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 01/24/2013] [Accepted: 04/01/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We investigated the prevalence of latent tuberculosis infection (LTBI) among the health care workers (HCWs) and analyzed its risk factors in South Korea. METHODS A standard questionnaire regarding the baseline demographics and risk factors for LTBI was given to each participant and tuberculin skin test (TST), QuantiFERON-TB GOLD In-Tube (QFT-GIT) assay, and chest radiography were performed. RESULTS A total of 493 participants, 152 (30.8%) doctors and 341 (69.2%) nurses were enrolled in eight tertiary referral hospitals. The mean age of the subjects was 30.6 years old, and 383 (77.7%) were female. Of the 152 doctors, 63 (41.4%) and 36 (23.7%) were positive by TST and by QTF-GIT, respectively, and among the 341 nurses, 119 (34.9%) and 49 (14.4%) had positive TST and QFT-GIT results, respectively. Overall, the agreement between the two tests was 0.22 by the chance corrected proportional agreement rate (kappa coefficient) in 493 subjects. Experience of working in tuberculosis (TB)-related departments was significantly associated with positive LTBI test results by QFT-GIT assay, not by TST. In multivariate analysis, only age was independently associated with increased risk of a positive TST result, while age and experience of working in TB-related departments (odds ratio, 2.29; 95% confidence interval, 1.01-5.12) were independently associated with increased risk of a positive QFT-GIT result. CONCLUSION A high prevalence of LTBI was found among South Korean HCWs. Considering the association between the experience of working in TB-related departments and high risk of LTBI, QFT-GIT may be a better diagnostic test for LTBI than TST in HCWs.
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Affiliation(s)
- Kyung-Wook Jo
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zhang X, Jia H, Liu F, Pan L, Xing A, Gu S, Du B, Sun Q, Wei R, Zhang Z. Prevalence and Risk Factors for Latent Tuberculosis Infection among Health Care Workers in China: A Cross-Sectional Study. PLoS One 2013; 8:e66412. [PMID: 23823871 PMCID: PMC3688921 DOI: 10.1371/journal.pone.0066412] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/06/2013] [Indexed: 11/23/2022] Open
Abstract
Background Health care workers (HCWs) are at risk of latent tuberculosis infection (LTBI). In China, tuberculosis (TB) is a major public health problem, but the prevalence of LTBI in HCWs especially in the hospital for pulmonary diseases has not been assessed enough. The aim of this study was to determine the prevalence and putative risk factors of LTBI among HCWs in a chest hospital and a TB research institute in China. Methodology/Principal Findings A cross-sectional study was conducted among HCWs in China in 2012. LTBI was assessed by T-SPOT.TB, and information on HCWs was collected using a standardised questionnaire. Risk factors for LTBI were analyzed by univariate and multivariate regression. The overall prevalence of LTBI among HCWs was 33.6%. Analyzed by job category, the highest prevalence was found among laboratory staff (43.4%). In the different workplaces, the proportion of LTBI was significantly higher among the high risk workplaces (37.4%) compared to the low risk workplaces. The duration of employment had a significant impact on the prevalence of LTBI. Positive T-SPOT.TB test results accounted for 17.6%, 16.8%, 23.5%, 41.8% and 41.6% in groups of ≤2, 3–5, 6–10, 11–20, and >20 working years respectively. In multivariate analysis, job categories (Laboratory staff [2.76 (95% CI: 1.36; 5.60)], technician staff [2.02 (95% CI: 1.12; 3.64)]); working duration as a HCW for 11 to 20 years [3.57 (95% CI: 1.46; 8.71)], and 20 years above [3.41 (95% CI: 1.28; 9.11)]; and the history of household TB contact [2.47 (95% CI: 1.15; 5.33)] were associated with increased risk of LTBI. Conclusions/Significance Prevalence of LTBI estimated by T-SPOT.TB is high among Chinese HCWs and working duration, job category and the history of household TB contact were associated with increased risk. These data highlight adequate infection control measures should be undertaken.
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Affiliation(s)
- Xia Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Hongyan Jia
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Fei Liu
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Liping Pan
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Aiying Xing
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Shuxiang Gu
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Boping Du
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Qi Sun
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Rongrong Wei
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
| | - Zongde Zhang
- Beijing Chest Hospital, Capital Medical University, Beijing Key Laboratory of Drug Resistance Tuberculosis Research, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, China
- * E-mail:
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Gran G, Aßmus J, Dyrhol-Riise AM. Screening for latent tuberculosis in Norwegian health care workers: high frequency of discordant tuberculin skin test positive and interferon-gamma release assay negative results. BMC Public Health 2013; 13:353. [PMID: 23590619 PMCID: PMC3637593 DOI: 10.1186/1471-2458-13-353] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 04/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) presents globally a significant health problem and health care workers (HCW) are at increased risk of contracting TB infection. There is no diagnostic gold standard for latent TB infection (LTBI), but both blood based interferon-gamma release assays (IGRA) and the tuberculin skin test (TST) are used. According to the national guidelines, HCW who have been exposed for TB should be screened and offered preventive anti-TB chemotherapy, but the role of IGRA in HCW screening is still unclear. Methods A total of 387 HCW working in clinical and laboratory departments in three major hospitals in the Western region of Norway with possible exposure to TB were included in a cross-sectional study. The HCW were asked for risk factors for TB and tested with TST and the QuantiFERON®TB Gold In-Tube test (QFT). A logistic regression model analyzed the associations between risk factors for TB and positive QFT or TST. Results A total of 13 (3.4%) demonstrated a persistent positive QFT, whereas 214 (55.3%) had a positive TST (≥ 6 mm) and 53 (13.7%) a TST ≥ 15 mm. Only ten (4.7%) of the HCW with a positive TST were QFT positive. Origin from a TB-endemic country was the only risk factor associated with a positive QFT (OR 14.13, 95% CI 1.37 - 145.38, p = 0.026), whereas there was no significant association between risk factors for TB and TST ≥ 15 mm. The five HCW with an initial positive QFT that retested negative all had low interferon-gamma (IFN-γ) responses below 0.70 IU/ml when first tested. Conclusions We demonstrate a low prevalence of LTBI in HCW working in hospitals with TB patients in our region. The “IGRA-only” seems like a desirable screening strategy despite its limitations in serial testing, due to the high numbers of discordant TST positive/IGRA negative results in HCW, probably caused by BCG vaccination or boosting due to repetitive TST testing. Thus, guidelines for TB screening in HCW should be updated in order to secure accurate diagnosis of LTBI and offer proper treatment and follow-up.
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Prevalence and incidence of latent tuberculosis infection in georgian healthcare workers. PLoS One 2013; 8:e58202. [PMID: 23536789 PMCID: PMC3607575 DOI: 10.1371/journal.pone.0058202] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tuberculosis is a major occupational hazard in low and middle-income countries. Limited data exist on serial testing of healthcare workers (HCWs) with interferon-γ release assays (IGRAs) for latent tuberculosis infection (LTBI), especially in low and middle-income countries. We sought to evaluate the rates of and risk factors for LTBI prevalence and LTBI test conversion among HCWs using the tuberculin skin test (TST) and QuantiFERON-TB Gold In-tube assay (QFT-GIT). METHODS A prospective longitudinal study was conducted among HCWs in the country of Georgia. Subjects completed a questionnaire, and TST and QFT-GIT tests were performed. LTBI testing was repeated 6-26 months after baseline testing. RESULTS Among 319 HCWs enrolled, 89% reported prior BCG vaccination, and 60% worked in TB healthcare facilities (HCFs). HCWs from TB HCFs had higher prevalence of positive QFT-GIT and TST than those from non-TB HCFs: 107/194 (55%) vs. 30/125 (31%) QFT-GIT positive (p<0.0001) and 128/189 (69%) vs. 64/119 (54%) TST positive (p = 0.01). There was fair agreement between TST and QFT-GIT (kappa = 0.42, 95% CI 0.31-0.52). In multivariate analysis, frequent contact with TB patients was associated with increased risk of positive QFT-GIT (aOR 3.04, 95% CI 1.79-5.14) but not positive TST. Increasing age was associated with increased risk of positive QFT-GIT (aOR 1.05, 95% CI 1.01-1.09) and TST (aOR 1.05, 95% CI 1.01-1.10). High rates of HCW conversion were seen: the QFT-GIT conversion rate was 22.8/100 person-years, and TST conversion rate was 17.1/100 person-years. In multivariate analysis, female HCWs had decreased risk of TST conversion (aOR 0.05, 95% CI 0.01-0.43), and older HCWs had increased risk of QFT-GIT conversion (aOR 1.07 per year, 95% CI 1.01-1.13). CONCLUSION LTBI prevalence and LTBI test conversion rates were high among Georgian HCWs, especially among those working at TB HCFs. These data highlight the need for increased implementation of TB infection control measures.
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Oni T, Gideon HP, Bangani N, Tsekela R, Seldon R, Wood K, Wilkinson KA, Goliath RT, Ottenhoff THM, Wilkinson RJ. Smoking, BCG and employment and the risk of tuberculosis infection in HIV-infected persons in South Africa. PLoS One 2012; 7:e47072. [PMID: 23056584 PMCID: PMC3467259 DOI: 10.1371/journal.pone.0047072] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 09/07/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The increased susceptibility to latent tuberculosis infection (LTBI) of HIV-1-infected persons represents a challenge in TB epidemic control. However few studies have evaluated LTBI predictors in a generalized HIV/TB epidemic setting. METHODS The study recruited 335 HIV-infected participants from Khayelitsha, Cape Town between February 2008 and November 2010. Tuberculin skin tests and interferon-gamma release assays were performed on all participants and active TB excluded using a symptom screen, TB microscopy and culture. RESULTS LTBI prevalence was 52.7% and 61.2% (TST and IGRA respectively). Being a recent TB contact (OR 2.07; 95% C.I. 1.15-3.69) was associated with TST positivity. Participants with a CD4>200 had a two-fold higher risk of IGRA positivity compared to those with CD4 counts <200 (OR 2.07; 95% C.I. 0.99-4.34). There was also a 19% increase in IGRA positivity risk for every additional year of schooling and a strong association between years of schooling and employment (p = 0.0004). A decreased risk of IGRA positivity was observed in persons with a BCG scar (OR 0.46; 95% C.I. 0.31-0.69) and in smokers (OR 0.47; 95% C.I. 0.23-0.96). CONCLUSION We report the novel findings of a decreased risk of IGRA positivity in HIV-infected smokers possibly due to decreased interferon production, and in the persons with a BCG scar suggesting a protective role for BCG in this population. We also found an increased risk of TST positivity in employed persons, possibly due to ongoing transmission in public modes of transport.
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Affiliation(s)
- Tolu Oni
- Clinical Infectious Disease Research Initiative, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
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Legesse M, Ameni G, Mamo G, Medhin G, Bjune G, Abebe F. Community-based cross-sectional survey of latent tuberculosis infection in Afar pastoralists, Ethiopia, using QuantiFERON-TB Gold In-Tube and tuberculin skin test. BMC Infect Dis 2011; 11:89. [PMID: 21477326 PMCID: PMC3080306 DOI: 10.1186/1471-2334-11-89] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 04/09/2011] [Indexed: 11/10/2022] Open
Abstract
Background There is little information concerning community-based prevalence of latent tuberculosis infection (LTBI) using T-cell based interferon-γ (IFN-γ) release assays (IGRAs), particularly in TB endemic settings. In this study, the prevalence of LTBI in the Afar pastoral community was assessed using QuantiFERON-TB Gold In-Tube (QFTGIT) and tuberculin skin tests (TST). Methods A community-based cross-sectional survey of LTBI involving 652 apparently healthy adult pastoralists was undertaken in the pastoral community of Amibara District of the Afar Region between April and June 2010. Results The prevalence of LTBI was estimated as 63.7% (363/570) using QFTGIT at the cut-off point recommended by the manufacturer (≥ 0.35 IU/ml IFN-γ), while it was 74.9% (427/570) using a cut-off point ≥ 0.1 IU/ml IFN-γ. The QFTGIT-based prevalence of LTBI was not significantly associated with the gender or age of the study participants. However, the prevalence of LTBI was 31.2% (183/587) using TST at a cut-off point ≥ 10 mm of skin indurations, and it was higher in males than females (36.8% vs. 23.5%, X2 = 11.76; p < 0.001). There was poor agreement between the results of the tests (k = 0.098, 95% CI, 0.08 - 0.13). However, there was a positive trend between QFTGIT and TST positivity (X2 = 96.76, P < 0.001). Furthermore, individuals with skin indurations ≥ 10 mm were 13.6 times more likely to have positive results using QFTGIT than individuals with skin indurations of 0 mm (adjusted OR = 13.6; 95%CI, 7.5 to 24.7, p < 0.001). Conclusions There is currently no agreed gold standard for diagnosis of LTBI. However, the higher prevalence of LTBI detected using QFTGIT rather than TST suggests that QFTGIT could be used for epidemiological studies concerning LTBI at the community level, even in a population unreactive to TST. Further studies of adults and children will be required to assess the effects of factors such as malnutrition, non-tuberculosis mycobacterial infections, HIV and parasitic infections on the performance of QFTGIT.
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Affiliation(s)
- Mengistu Legesse
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
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Diel R, Loddenkemper R, Nienhaus A. Evidence-based comparison of commercial interferon-gamma release assays for detecting active TB: a metaanalysis. Chest 2009; 137:952-68. [PMID: 20022968 DOI: 10.1378/chest.09-2350] [Citation(s) in RCA: 266] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Test accuracy of interferon-gamma release assays (IGRAs) for diagnosing TB differs when using older or precommercial tools and inconsistent diagnostic criteria. This metaanalysis critically appraises studies investigating sensitivity and specificity of the commercial T-Spot.TB and the QuantiFERON-TB Gold In-Tube Assay (QFT-IT) among definitely confirmed TB cases. We searched Medline, EMBASE, and Cochrane bibliographies of relevant articles. Sensitivities, specificities, and indeterminate rates were pooled using a fixed effect model. Sensitivity of the tuberculin skin test (TST) was evaluated in the context of IGRA studies. In addition, the rates of indeterminates of both IGRAs were assessed. The pooled sensitivity of TST was 70% (95% CI, 0.67-0.72) compared with 81% (95% CI, 0.78-0.83) for the QFT-IT and 88% (95% CI, 0.85-0.90) for the T-Spot.TB. Sensitivity increased to 84% (95%CI, 0.81-0.87) and 89% (95% CI, 0.86-0.91) for the QFT-IT and T-Spot.TB, respectively, when restricted to performance in developed countries. In contrast, specificity of the QFT-IT was 99% (95% CI, 0.98-1.00) vs 86% for the T-Spot.TB (95% CI, 0.81-0.90). The pooled rate of indeterminate results was low, 2.1% (95% CI, 0.02-0.023) for the QFT-IT and 3.8% (95% CI, 0.035-0.042) for the T-Spot.TB, increasing to 4.4% (95% CI, 0.039-0.05) and 6.1% (95% CI, 0.052-0.071), respectively, among immunosuppressed hosts. The newest commercial IGRAs are superior, in comparison with the TST, for detecting confirmed active TB disease, especially when performed in developed countries.
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Affiliation(s)
- Roland Diel
- Department of Pulmonary Medicine, Hannover Medical School (MHH), Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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Metcalfe JZ, Cattamanchi A, Vittinghoff E, Ho C, Grinsdale J, Hopewell PC, Kawamura LM, Nahid P. Evaluation of quantitative IFN-gamma response for risk stratification of active tuberculosis suspects. Am J Respir Crit Care Med 2009; 181:87-93. [PMID: 19797760 DOI: 10.1164/rccm.200906-0981oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The contribution of interferon-gamma release assays (IGRAs) to appropriate risk stratification of active tuberculosis suspects has not been studied. OBJECTIVES To determine whether the addition of quantitative IGRA results to a prediction model incorporating clinical criteria improves risk stratification of smear-negative-tuberculosis suspects. METHODS Clinical data from tuberculosis suspects evaluated by the San Francisco Department of Public Health Tuberculosis Control Clinic from March 2005 to February 2008 were reviewed. We excluded tuberculosis suspects who were acid fast-bacilli smear-positive, HIV-infected, or under 10 years of age. We developed a clinical prediction model for culture-positive disease and examined the benefit of adding quantitative interferon (IFN)-gamma results measured by QuantiFERON-TB Gold (Cellestis, Carnegie, Australia). MEASUREMENTS AND MAIN RESULTS Of 660 patients meeting eligibility criteria, 65 (10%) had culture-proven tuberculosis. The odds of active tuberculosis increased by 7% (95% confidence interval [CI], 3-11%) for each doubling of IFN-gamma level. The addition of quantitative IFN-gamma results to objective clinical data significantly improved model performance (c-statistic 0.71 vs. 0.78; P < 0.001) and correctly reclassified 32% of tuberculosis suspects (95% CI,11-52%; P < 0.001) into higher-risk or lower-risk categories. However, quantitative IFN-gamma results did not significantly improve appropriate risk reclassification beyond that provided by clinician assessment of risk (4%; 95% CI, -7 to +22%; P = 0.14). CONCLUSIONS Higher quantitative IFN-gamma results were associated with active tuberculosis, and added clinical value to a prediction model incorporating conventional risk factors. Although this benefit may be attenuated within highly experienced centers, the predictive accuracy of quantitative IFN-gamma levels should be evaluated in other settings.
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Affiliation(s)
- John Z Metcalfe
- San Francisco General Hospital, University of California, 94110-0111, USA.
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Lien LT, Hang NTL, Kobayashi N, Yanai H, Toyota E, Sakurada S, Huu Thuong P, Cuong VC, Nanri A, Mizoue T, Matsushita I, Harada N, Higuchi K, Tuan LA, Keicho N. Prevalence and risk factors for tuberculosis infection among hospital workers in Hanoi, Viet Nam. PLoS One 2009; 4:e6798. [PMID: 19710920 PMCID: PMC2728839 DOI: 10.1371/journal.pone.0006798] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 07/27/2009] [Indexed: 11/18/2022] Open
Abstract
Background Transmission of tuberculosis (TB) to health care workers (HCWs) is a global issue. Although effective infection control measures are expected to reduce nosocomial TB, HCWs' infection has not been assessed enough in TB high burden countries. We conducted a cross-sectional study to determine the prevalence of TB infection and its risk factors among HCWs in Hanoi, Viet Nam. Methodology/Principal Findings A total of 300 HCWs including all staff members in a municipal TB referral hospital received an interferon-gamma release assay (IGRA), QuantiFERON-TB Gold In-TubeTM, followed by one- and two-step tuberculin skin test (TST) and a questionnaire-based interview. Agreement between the tests was evaluated by kappa statistics. Risk factors for TB infection were analyzed using a logistic regression model. Among the participants aged from 20 to 58 years (median = 40), prevalence of TB infection estimated by IGRA, one- and two-step TST was 47.3%, 61.1% and 66.3% respectively. Although the levels of overall agreement between IGRA and TST were moderate, the degree of agreement was low in the group with BCG history (kappa = 0.29). Working in TB hospital was associated with twofold increase in odds of TB infection estimated by IGRA. Increased age, low educational level and the high body mass index also demonstrated high odds ratios of IGRA positivity. Conclusions/Significance Prevalence of TB infection estimated by either IGRA or TST is high among HCWs in the hospital environment for TB care in Viet Nam and an infection control program should be reinforced. In communities with heterogeneous history of BCG vaccination, IGRA seems to estimate TB infection more accurately than any other criteria using TST.
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Affiliation(s)
- Luu Thi Lien
- Hanoi Tuberculosis and Lung Disease Hospital, Hanoi, Viet Nam
| | - Nguyen Thi Le Hang
- International Medical Center of Japan - Bach Mai Hospital (IMCJ-BMH) Medical Collaboration Center, Hanoi, Viet Nam
| | - Nobuyuki Kobayashi
- Department of Respiratory Medicine, Toyama Hospital, International Medical Center of Japan, Tokyo, Japan
| | - Hideki Yanai
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Emiko Toyota
- Department of Respiratory Diseases, NHO Tokyo Hospital, Tokyo, Japan
| | - Shinsaku Sakurada
- Department of Respiratory Diseases, Research Institute, International Medical Center of Japan, Tokyo, Japan
| | - Pham Huu Thuong
- Hanoi Tuberculosis and Lung Disease Hospital, Hanoi, Viet Nam
| | - Vu Cao Cuong
- General Planning Department, Hanoi Tuberculosis and Lung Disease Hospital, Hanoi, Viet Nam
| | - Akiko Nanri
- Department of Epidemiology and International Health, Research Institute, International Medical Center of Japan, Tokyo, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and International Health, Research Institute, International Medical Center of Japan, Tokyo, Japan
| | - Ikumi Matsushita
- Department of Respiratory Diseases, Research Institute, International Medical Center of Japan, Tokyo, Japan
| | - Nobuyuki Harada
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Tokyo, Japan
| | - Kazue Higuchi
- Department of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Tokyo, Japan
| | | | - Naoto Keicho
- Department of Respiratory Diseases, Research Institute, International Medical Center of Japan, Tokyo, Japan
- * E-mail:
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Casas I, Latorre I, Esteve M, Ruiz-Manzano J, Rodriguez D, Prat C, García-Olivé I, Lacoma A, Ausina V, Domínguez J. Evaluation of interferon-gamma release assays in the diagnosis of recent tuberculosis infection in health care workers. PLoS One 2009; 4:e6686. [PMID: 19701460 PMCID: PMC2726945 DOI: 10.1371/journal.pone.0006686] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 08/01/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Health care workers (HCWs) are a group at risk of latent tuberculosis infection (LTBI). The aims of this study were to determine IFN-gamma response by QuantiFERON-TB GOLD In Tube (QFN-G-IT) and T-SPOT.TB in HCWs, comparing the results with tuberculin skin test (TST); and to analyze the capacity of IFN-gamma tests to detect recent versus remote LTBI with a prolonged stimulation test (PST). METHODOLOGY/PRINCIPAL FINDINGS A total of 147 HCWs were enrolled; 23 of whom were BCG vaccinated. 95 HCWs (64.6%) had a previous positive TST and were not retested; and 52 HCWs had a previous negative TST or were tested for the first time. When we analysed individuals without previous positive TST, the number of positive results for T-SPOT.TB was 12/52 (23.1%); and for QFN-G-IT, 9/52 (17.3%). The global concordance (kappa) between T-SPOT.TB and QFN-G-IT with TST was 0.754 and 0.929 respectively. Of individuals with previous positive TST, T-SPOT.TB and QFN-G-IT were negative in 51.6% (49/95) and 62.1% (59/95) respectively, decreasing the concordance to 0.321 and 0.288, respectively. In non-BCG vaccinated HCWs with previous positive TST a positive IFN-gamma test was associated with degree of exposure and diameter of TST. PST was performed in 24 HCW with previous positive TST and negative IFN-gamma tests. PST was developed in 3 cell cultures stimulated with medium alone, ESAT-6 and CFP-10, respectively. In the third and sixth day of incubation period, part of the supernatants were replaced with complete medium supplemented with (rIL)-2. On day 9, ELISPOT assay was performed. In 14 samples PST was not valid due to not having enough cells. In 8 cases, the response was negative, and in 2 cases positive, suggesting that these patients were infected with Mycobacterium tuberculosis in some point in the past. CONCLUSIONS Both IFN-gamma tests showed a similar number of positive results, and concordance between the tests was excellent. None of the tests was affected by prior BCG vaccination. IFN-gamma tests are a useful tool for detecting recent infection in HCW population.
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Affiliation(s)
- Irma Casas
- Servei de Medicina Preventiva, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Irene Latorre
- Servei de Microbiologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Maria Esteve
- Servei de Medicina Preventiva, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Juan Ruiz-Manzano
- Servei de Pneumologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Dora Rodriguez
- Servei de Medicina Preventiva, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Cristina Prat
- Servei de Microbiologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Ignasi García-Olivé
- Servei de Pneumologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Alicia Lacoma
- Servei de Microbiologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Vicente Ausina
- Servei de Microbiologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
| | - Jose Domínguez
- Servei de Microbiologia, Hospital Universitari “Germans Trias i Pujol” Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- CIBER Enfermedades Respiratorias, Badalona, Spain
- * E-mail:
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Swindells JE, Aliyu SH, Enoch DA, Abubakar I. Role of interferon-gamma release assays in healthcare workers. J Hosp Infect 2009; 73:101-8. [PMID: 19699551 DOI: 10.1016/j.jhin.2009.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Indexed: 10/20/2022]
Abstract
The advent of interferon-gamma release assays (IGRAs) provides new options for detection of latent tuberculosis infection (LTBI). This is particularly relevant to healthcare workers (HCWs), who are at higher risk of infection, but who have often also been vaccinated. In this article, we discuss the role of IGRAs for the diagnosis of LTBI in various healthcare settings. A search was performed for studies that reported data on IGRAs in HCWs in the last 18 years. Twenty-two studies met the inclusion criteria. IGRAs showed poor agreement with the tuberculin skin test (TST), except in countries with high incidences of tuberculosis (TB), but generally correlated better with markers of exposure to TB including during contact investigation. The T-SPOT.TB assay has not been adequately assessed in HCWs; the few studies available showed enhanced specificity of T-SPOT.TB when compared to TST. This review confirms the utility of IGRAs as important tools in the prevention and control of tuberculosis in healthcare settings.
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Affiliation(s)
- J E Swindells
- Department of Microbiology, City Hospital, Dudley Road, Birmingham, UK
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T-cell interferon-gamma release assays for the rapid immunodiagnosis of tuberculosis: clinical utility in high-burden vs. low-burden settings. Curr Opin Pulm Med 2009; 15:188-200. [PMID: 19387262 DOI: 10.1097/mcp.0b013e32832a0adc] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW The utility of T-cell interferon-gamma (IFN-gamma) responses to Mycobacterium tuberculosis specific antigens [interferon-gamma release assays (IGRAs)] in high-burden settings remains unclear and there is growing evidence that IGRA performance varies across high tuberculosis (TB) burden vs. low TB burden settings. Here we review the evidence supporting the utility of IGRAs in specific subgroups and compare their performance in high-burden vs. low-burden settings. RECENT FINDINGS Although the IGRA, compared with the tuberculin skin test (TST), has greater specificity in BCG-vaccinated individuals, treatment of latent tuberculosis infection is not a priority in high-burden setting. Nevertheless, in high-burden settings, the TST performs reasonably well and correlates as well, or better, with proxy measures of exposure. SUMMARY IGRAs may still be useful in high-burden settings in specific subgroups at high risk of progression, including young children, HIV-infected individuals and healthcare workers, but this requires confirmation. Although the IGRAs cannot distinguish between latent and active TB, their utility as rule-out tests, when combined with smear microscopy or the TST, requires further study. Prospective studies are required in high-burden settings to confirm whether IFN-gamma responses are predictive of high risk of progression to active TB, particularly in HIV-infected individuals.
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Use of interferon gamma-based assay to diagnose tuberculosis infection in health care workers after short term exposure. BMC Infect Dis 2009; 9:60. [PMID: 19432995 PMCID: PMC2690599 DOI: 10.1186/1471-2334-9-60] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 05/11/2009] [Indexed: 11/11/2022] Open
Abstract
Background We intended to assess the risk for health care workers (HCWs) of acquiring M. tuberculosis infection after exposure to patients with sputum-smear positive pulmonary tuberculosis at three University Hospitals (Ullevål, Akershus, and Haukeland) in Norway. Methods We tested 155 exposed health care workers and 48 healthy controls both with a tuberculin skin test (Mantoux) and the T-SPOT.TB test, a recently developed interferon-γ release assays based on the M. tuberculosis-specific ESAT-6 and CFP10 antigens, to investigate if this test might improve infection control measures. Results Among the 155 exposed HCWs tested in this study, 27 individuals were defined as newly infected cases by TST after recent exposure, while only 3 of these had a positive T-SPOT.TB test. The number of T-SPOT.TB positives represents 11% of the individuals defined as recently infected by TST after exposure (3/27) and 2% of the total number of exposed people tested (3/155). In addition, 15 individuals had been previously defined as infected by TST before exposure of whom 2 subjects were T-SPOT.TB positive. All individuals detected as T-SPOT.TB positive belonged to the TST positive group (> 15 mm), and the percentage concordance between T-SPOT.TB and TST, including both previously and newly infected subjects, was 12% (5/42). The 48 control participants used in the study were all T-SPOT.TB negative, but 3 of these subjects were TST positive. Conclusion Our data indicate that the frequency of latent TB in the total cohort of HCWs is 3%, whereas the rate of transmission of TB to exposed individuals is approximately 2% and occurs through exposure periods of short duration. Thus, the risk of TB transmission to HCWs following TB exposure in a hospital setting in Norway is low, and improved screening approaches will benefit from the application of specific interferon-γ release assays.
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Asylum seekers' expectations of and trust in general practice: a qualitative study. Br J Gen Pract 2008; 58:e1-11. [PMID: 19068152 DOI: 10.3399/bjgp08x376104] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The UK has substantial minority populations of short-term and long-term migrants from countries with various types of healthcare systems. AIM This study explored how migrants' previous knowledge and experience of health care influences their current expectations of health care in a system relying on clinical generalists performing a gatekeeping role. DESIGN OF STUDY Two qualitative methods. SETTING Glasgow, UK. METHOD Focus groups or semi-structured interviews were conducted with 52 asylum seekers. Analyses identified several areas where previous experience affected current expectations. An overview of health systems in each country of origin was established by combining responders' accounts with World Health Organization statistics. RESULTS Asylum seekers had previous experience of a diverse range of healthcare systems, most of which were characterised by a lack of GPs and direct access to hospital-based specialists. For some responders, war or internal conflict resulted in a complete breakdown of healthcare systems. Responders' accounts also highlighted the difficulties that marginalised groups had in accessing health care. Although asylum seekers were generally pleased with the care they received from the NHS, there were areas where they experienced difficulties: confidence in their GP and access to hospital-based specialists and medication. These difficulties encountered might be explained by previous experience. CONCLUSION GPs and other healthcare professionals need to be aware that experience of different systems of care can have an impact on individuals' expectations in a GP-led system. If these are not acknowledged and addressed, a lack of confidence and trust in the GP may undermine the effectiveness of the clinical consultation.
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Pollock NR, Campos-Neto A, Kashino S, Napolitano D, Behar SM, Shin D, Sloutsky A, Joshi S, Guillet J, Wong M, Nardell E. Discordant QuantiFERON-TB Gold test results among US healthcare workers with increased risk of latent tuberculosis infection: a problem or solution? Infect Control Hosp Epidemiol 2008; 29:878-86. [PMID: 18713053 DOI: 10.1086/590262] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In late 2006, our hospital implemented use of the QuantiFERON-TB Gold (QFT-G) assay, a whole-blood interferon-gamma release assay, for detection of tuberculosis infection. All newly hired healthcare workers (HCWs) with positive Mantoux tuberculin skin test (TST) results were routinely tested with the QFT-G assay, to take advantage of its higher specificity. We then undertook a quality assurance review to evaluate the QFT-G test results in HCWs with multiple risk factors for latent tuberculosis infection (LTBI). METHODS The clinical records for TST-positive HCWs tested with the QFT-G assay were reviewed. HCWs with 2 or more risk factors commonly associated with LTBI were classified as "increased risk" (IR). IR HCWs who had negative QFT-G test results underwent repeat QFT-G testing and were offered testing with a different interferon-gamma release assay (T-SPOT.TB) and with extended T cell stimulation assays. RESULTS Of 143 TST-positive HCWs tested with the QFT-G assay, 26 (18%) had positive results, 115 (81%) had negative results, and 2 (1%) had indeterminate results. Of 82 IR HCWs, 23 (28%) had positive QFT-G test results, and 57 (70%) had negative results. Of the 57 IR HCWs with negative results, 43 underwent repeat QFT-G testing: 41 had negative results again, and 2 had positive results. These 43 HCWs were also offered additional testing with the T-SPOT.TB diagnostic, and 36 consented: 31/36 tested negative, and 5/36 tested positive. Extended assays using the antigens ESAT-6 and CFP-10 confirmed the positive results detected by the overnight assays and yielded positive results for an additional 7/36 (19%) of individuals; strikingly, all 36 HCWs had strongly positive test results with assays using purified protein derivative. CONCLUSIONS The extreme discordance between the results of our clinical diagnostic algorithm and the results of QFT-G testing raises concern about the sensitivity of the QFT-G assay for detection of LTBI in our HCWs. Results of extended stimulation assays suggest that many of our IR HCWs have indeed been sensitized to Mycobacterium tuberculosis. It is possible that the QFT-G assay identifies those at higher reactivation risk rather than all previously infected, but, in the absence of long-term follow-up data, we should interpret negative QFT-G results with some caution.
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Affiliation(s)
- Nira R Pollock
- Department of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115, USA
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Mirtskhulava V, Kempker R, Shields KL, Leonard MK, Tsertsvadze T, del Rio C, Salakaia A, Blumberg HM. Prevalence and risk factors for latent tuberculosis infection among health care workers in Georgia. Int J Tuberc Lung Dis 2008; 12:513-519. [PMID: 18419886 PMCID: PMC2742226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major public health problem in Georgia, but few TB infection control measures have been implemented in health care facilities. OBJECTIVE To assess the prevalence and risk factors for latent TB infection (LTBI) among Georgian health care workers (HCWs) using two diagnostic tests, the tuberculin skin test (TST) and the QuantiFERON-TB Gold In Tube test (QFT-3G), an interferon-gamma release assay. METHODS A cross-sectional study was conducted between June and August 2006 among HCWs at the Georgian National TB Program. RESULTS Of 265 HCWs enrolled, 177 (67%) had a positive TST and 159 (60%) had a positive QFT-3G; 203 (77%) had a positive result for at least one of the tests and 50% tested positive for both tests. There was moderately good agreement between the tests (74%, kappa = 0.43, 95%CI 0.33-0.55). In multivariate analysis, employment for >5 years was associated with increased risk of a positive TST (OR 5.09, 95%CI 2.77-9.33) and QFT-3G (OR 2.26, 95%CI 1.27-4.01); age >30 years was associated with an increased risk of a positive QFT-3G (OR 2.91, 95%CI 1.32-6.43). DISCUSSION A high prevalence of LTBI was found among Georgian HCWs and longer duration of employment was associated with increased risk. These data highlight the need for effective TB infection control measures and provide important baseline information as TB infection control measures are implemented.
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Affiliation(s)
- V Mirtskhulava
- National Center for Tuberculosis and Lung Diseases/National Tuberculosis Program, Tbilisi, Georgia, USA.
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