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Yang H, Park H. Factors influencing the initiation and adherence of LTBI treatment in healthcare workers: a systematic review. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2021; 77:76-86. [PMID: 34184972 DOI: 10.1080/19338244.2021.1943642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Despite the importance of latent tuberculosis infection (LTBI) treatment and management in healthcare workers (HCWs), only a few studies have provided a comprehensive review of factors associated with the success rate of each stage of the LTBI treatment, as well as strategies to improve treatment adherence. This study investigated factors and determinants of patient losses at each stage of the entire cascade of LTBI in HCWs. Studies were extracted from PubMed, EBSCOhost, EMBASE, Cochrane Library, and ScienceDirect. Our study found poor completion rates of LTBI treatment in HCWs. The main reason for not visiting the outpatient clinic or not accepting treatment was related to the demographic characteristics, whereas adverse drug effects were the main reason for treatment discontinuation. These findings suggest that tailored interventions must be developed to improve the success rate at each stage of the LTBI treatment in HCWs.
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Affiliation(s)
- Hyunju Yang
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
| | - Hyunyoung Park
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea
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Sirinapakul P, Chaiear N, Krisorn P. Validity and Reliability of Self-Assessment Tool for Risk Prioritization Following Exposure to Tuberculosis in a Hospital Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083981. [PMID: 33918945 PMCID: PMC8070430 DOI: 10.3390/ijerph18083981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
The Modified Self-Assessment (MSA) and Present Self-Assessment (PSA) forms are questionnaires used to prioritize the risk of infection of health workers exposed to tuberculosis (TB) in Srinagarind Hospital in Thailand. As MSA was developed from PSA, the validity and reliability of MSA need to be assessed. The research aim is to examine the content validity of MSA and to assess the respective reliability of MSA and PSA vis-à-vis expert opinion. Seven experts determined the content validity index (CVI) of MSA. MSA and PSA were used to prioritize the TB contact of 108 subjects, and we compared the result with the risk assessed by the experts. The respective Kappa agreements between MSA and PSA and the experts were used to assess reliability. The result of the content validity index revealed that MSA had I-CVI > 0.83 for all questions and an S-CVI/Ave above 0.90 for all factors. The Kappa agreement of contact priority between MSA and the experts was 0.80; it was 0.58 between PSA and the experts. MSA can, thus, be used to prioritize contact with tuberculosis in Srinagarind Hospital. MSA is a valid risk communication tool for aerosol-generating procedures. Further study should be conducted in other hospitals, and the number of participants should be increased in order to come to a concrete result.
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Affiliation(s)
- Piyapong Sirinapakul
- Division of Occupational Medicine, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.S.); (P.K.)
| | - Naesinee Chaiear
- Division of Occupational Medicine, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.S.); (P.K.)
- Occupational Health and Safety Office, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
- Correspondence: ; Tel.: +66-4336-3588
| | - Phanumas Krisorn
- Division of Occupational Medicine, Department of Community Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand; (P.S.); (P.K.)
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Factors Associated with Latent Tuberculosis Infection among the Hospital Employees in a Tertiary Hospital of Northeastern Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186876. [PMID: 32967073 PMCID: PMC7557613 DOI: 10.3390/ijerph17186876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/25/2022]
Abstract
Latent tuberculosis infection (LTBI) can develop into tuberculosis (TB). The WHO requires the discovery and management of LTBI among high-risk groups. Health care workers (HCWs) constitute a high-risk group. Factors associated with LTBI among HCWs in Thailand need further study. The current study aimed to explore the factors related to LTBI among Thai HCWs. A hospital-based, matched case-control study was conducted. All cases and controls were HCWs at a tertiary hospital in northeastern Thailand. Between 2017 and 2019, a total of 85 cases of interferon-γ release assays (IGRAs)-proven LTBI, and 170 control subjects were selected from a hospital (two controls per case). The two recruited controls were individually matched with LTBI cases by sex and age (±5 years). Secondary data were obtained from the occupational health and safety office. Case HCWs had a higher proportion of significant factors than control HCWs (i.e., working closely with pulmonary TB-94.1% vs. 88.8%, and working in the area of aerosol-generating procedures (AGPs) 81.2% vs. 69.4%). The bivariate conditional logistic regression showed that the occurrence of LTBI in HCWs was statistically significant (p-value < 0.05), particularly with respect to: workplaces of AGPs (crude OR = 1.90, 95% CI: 1.01-3.58, p = 0.041); among HCWs performing AGPs (crude OR = 2.04, 95% CI: 1.20, 3.48, p = 0.007); and, absent Bacille Calmette-Guérin (BCG) scar (crude OR = 2.59, 95% CI: 1.50-4.47, p = 0.001). Based on the multivariable conditional logistics analysis, HCWs who performed AGPs while contacting TB cases had a statistically significant association with LTBI (adjusted OR = 1.82, 95% CI: 1.04-3.20, p = 0.035). HCWs who reported the absence of a BCG scar had a statistically significant association with LTBI (adjusted OR = 2.49, 95% CI: 1.65-5.36, p = 0.001), whereas other factors including close contact with TB (adjusted OR = 2.44, 95% CI: 0.74, 8.09, p = 0.123) were not significantly associated with LTBI. In conclusion, HCWs who performed AGPs and were absent a BCG scar had a significant association with LTBI, while other factors played a less critical role.
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Lee H, Koo GW, Min JH, Park TS, Park DW, Moon JY, Kim SH, Kim TH, Yoon HJ, Sohn JW. Factors associated with non-initiation of latent tuberculosis treatment among healthcare workers with a positive interferon-gamma releasing assay. Sci Rep 2019; 9:61. [PMID: 30635600 PMCID: PMC6329765 DOI: 10.1038/s41598-018-37319-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/04/2018] [Indexed: 11/09/2022] Open
Abstract
Despite widespread use of the interferon-gamma release assay for the diagnosis of latent tuberculosis infection (LTBI), the initiation rate of and factors associated with LTBI treatment among healthcare workers (HCWs) have not been studied in depth. The aim of this study was to evaluate the initiation rate of LTBI treatment and also to identify any factors associated with non-initiation of LTBI treatment among HCWs. A retrospective cohort study of 293 HCWs with LTBI was performed at a teaching hospital in Korea. LTBI was diagnosed using QuantiFERON-TB Gold In-Tube tests (Cellestis Ltd., Carnegie, VIC, Australia). Of the 293 HCWs with LTBI, 189 HCWs (64.5%) visited an outpatient clinic for a medical consultation regarding LTBI treatment. Of these, 128 (67.7%) consented to LTBI treatment for a 43.7% LTBI treatment initiation rate. Upon multivariable analysis, having a liver disease or currently taking hepatotoxic drugs (adjusted odds ratio [OR] = 12.03, 95% confidence interval [CI] = 3.12–46.35), being a physician (adjusted OR = 14.01, 95% CI = 2.82–69.74) and other patient-related HCWs (adjusted OR = 3.58, 95% CI = 1.46–8.78), and years of employment ≥20 years (adjusted OR = 4.77, 95% CI = 1.74–13.12) were independent factors associated with the non-initiation of LTBI treatment. Upon bivariate multivariable analysis, while having a liver disease or currently taking hepatotoxic drugs (adjusted OR = 12.85, 95% CI = 3.06–55.92), being a physician (adjusted OR = 28.43, 95% CI = 4.78–169.28) and other patient-related HCWs (adjusted OR = 4.80, 95% CI = 1.56–14.74), and years of employment ≥20 years (adjusted OR = 4.55, 95% CI = 1.37–15.15) were factors associated with no outpatient clinic visit for a consultation of LTBI treatment, having a liver disease or currently taking hepatotoxic drugs (adjusted OR = 11.76, 95% CI = 2.68–51.73) and years of employment ≥20 years (adjusted OR = 5.29, 95% CI = 1.38–20.19) were factors associated with refusal of LTBI treatment after a consultation. The overall initiation rate of LTBI treatment was suboptimal in HCWs with LTBI diagnosed using an interferon-gamma releasing assay. Having a liver disease or currently taking hepatotoxic drugs, being a physician and other patient-related HCWs, and years of employment ≥20 years were associated with non-initiation of LTBI treatment.
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Affiliation(s)
- Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Gun Woo Koo
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji-Hee Min
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tai Sun Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Won Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae Hyung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jang Won Sohn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
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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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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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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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Doan TN, Eisen DP, Rose MT, Slack A, Stearnes G, McBryde ES. Interferon-gamma release assay for the diagnosis of latent tuberculosis infection: A latent-class analysis. PLoS One 2017; 12:e0188631. [PMID: 29182688 PMCID: PMC5705142 DOI: 10.1371/journal.pone.0188631] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/11/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Accurate diagnosis and subsequent treatment of latent tuberculosis infection (LTBI) is essential for TB elimination. However, the absence of a gold standard test for diagnosing LTBI makes assessment of the true prevalence of LTBI and the accuracy of diagnostic tests challenging. Bayesian latent class models can be used to make inferences about disease prevalence and the sensitivity and specificity of diagnostic tests using data on the concordance between tests. We performed the largest meta-analysis to date aiming to evaluate the performance of tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) for LTBI diagnosis in various patient populations using Bayesian latent class modelling. METHODS Systematic search of PubMeb, Embase and African Index Medicus was conducted without date and language restrictions on September 11, 2017 to identify studies that compared the performance of TST and IGRAs for LTBI diagnosis. Two IGRA methods were considered: QuantiFERON-TB Gold In Tube (QFT-GIT) and T-SPOT.TB. Studies were included if they reported 2x2 agreement data between TST and QFT-GIT or T-SPOT.TB. A Bayesian latent class model was developed to estimate the sensitivity and specificity of TST and IGRAs in various populations, including immune-competent adults, immune-compromised adults and children. A TST cut-off value of 10 mm was used for immune-competent subjects and 5 mm for immune-compromised individuals. FINDINGS A total of 157 studies were included in the analysis. In immune-competent adults, the sensitivity of TST and QFT-GIT were estimated to be 84% (95% credible interval [CrI] 82-85%) and 52% (50-53%), respectively. The specificity of QFT-GIT was 97% (96-97%) in non-BCG-vaccinated and 93% (92-94%) in BCG-vaccinated immune-competent adults. The estimated figures for TST were 100% (99-100%) and 79% (76-82%), respectively. T-SPOT.TB has comparable specificity (97% for both tests) and better sensitivity (68% versus 52%) than QFT-GIT in immune-competent adults. In immune-compromised adults, both TST and QFT-GIT display low sensitivity but high specificity. QFT-GIT and TST are equally specific (98% for both tests) in non-BCG-vaccinated children; however, QFT-GIT is more specific than TST (98% versus 82%) in BCG-vaccinated group. TST is more sensitive than QFT-GIT (82% versus 73%) in children. CONCLUSIONS This study is the first to assess the utility of TST and IGRAs for LTBI diagnosis in different population groups using all available data with Bayesian latent class modelling. Our results challenge the current beliefs about the performance of LTBI screening tests, and have important implications for LTBI screening policy and practice. We estimated that the performance of IGRAs is not as reliable as previously measured in the general population. However, IGRAs are not or minimally affected by BCG and should be the preferred tests in this setting. Adoption of IGRAs in settings where BCG is widely administered will allow for a more accurate identification and treatment of LTBI.
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Affiliation(s)
- Tan N. Doan
- Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- * E-mail:
| | - Damon P. Eisen
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Morgan T. Rose
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Slack
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Grace Stearnes
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Emma S. McBryde
- Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
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Balkhy HH, El Beltagy K, El-Saed A, Aljasir B, Althaqafi A, Alothman AF, Alshalaan M, Al-Jahdali H. Comparison of QuantiFERON-TB gold in tube test versus tuberculin skin test for screening of latent tuberculosis infection in Saudi Arabia: A population-based study. Ann Thorac Med 2016; 11:197-201. [PMID: 27512509 PMCID: PMC4966222 DOI: 10.4103/1817-1737.185759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES: To compare QuantiFERON-TB gold in tube (QFT-GIT) test with tuberculin skin test (TST) in detecting latent tuberculosis infection (LTBI) among a general population in Saudi Arabia. METHODS: A population-based cross-sectional study was conducted between July 2010 and March 2013 among individuals randomly selected from the list of those receiving care at primary healthcare centers in three provinces of Saudi Arabia; Central, Western, and Eastern provinces. Those younger than 5 years, immunocompromised, had a current or previous history of active TB, LTBI, or who were receiving anti-TB medications were excluded. Informed consent was obtained before the study questionnaire was completed. Participants were then evaluated for LTBI using QFT-GIT test followed immediately by TST. RESULTS: Of the 1369 subjects included in the final analysis, QFT-GIT was positive in 124 (9.1%) and TST was positive in 127 (9.3%). Positive concordance was observed in 49 (3.6%) subjects while negative concordance was observed in 1167 (85.2%) subjects. The overall agreement between the two tests was 88.8% with a significant kappa (κ) test (κ = 0.332, P < 0.001). Concordance was significantly higher in younger age, female gender, single status, students, primary education, living in middle-sized families, and never smoked. CONCLUSIONS: The overall agreement of TST and QFT-GIT for the detection of LTBI among a Saudi general population was 88.8%. QFT-GIT is probably comparable to TST for detecting LTBI in an intermediate TB burden country with high at birth bacille calmette guerin vaccination coverage. Further prospective studies are needed to compare the ability of both tests to predict TB disease.
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Affiliation(s)
- Hanan H Balkhy
- Department of Pediatrics, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia; Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Kamel El Beltagy
- Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Public Health and Community Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Aiman El-Saed
- Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Badr Aljasir
- Department of Pediatrics, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Preventive Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulhakeem Althaqafi
- Department of Pediatrics, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Infection Prevention and Control, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Adel F Alothman
- Department of Pediatrics, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammad Alshalaan
- Department of Pediatrics, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- Department of Pediatrics, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Mok JH. Diagnosis and Treatment of Latent Tuberculosis Infection in Healthcare Workers. Tuberc Respir Dis (Seoul) 2016; 79:127-33. [PMID: 27433172 PMCID: PMC4943896 DOI: 10.4046/trd.2016.79.3.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/12/2016] [Accepted: 01/19/2016] [Indexed: 11/24/2022] Open
Abstract
Tuberculosis (TB) is one of the most important occupational risks for healthcare workers (HCWs) in South Korea. Many policies regarding the control and prevention of TB in healthcare settings recommend that HCWs are tested for latent tuberculosis infection (LTBI) in addition to active TB. Moreover, the Korean Tuberculosis Prevention Act also recommends that HCWs receive regular testing for LTBI. However, there are no specific or detailed guidelines for dealing with LTBI in HCWs. Herein, we discuss the diagnosis and treatment of LTBI in HCWs and focus particularly on the baseline screening of hired HCWs, routine follow-up, and contact investigation.
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Affiliation(s)
- Jeong Ha Mok
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.; Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Al Hajoj S, Varghese B, Datijan A, Shoukri M, Alzahrani A, Alkhenizan A, AlSaif A, Althawadi S, Fernandez G, Alrajhi A. Interferon Gamma Release Assay versus Tuberculin Skin Testing among Healthcare Workers of Highly Diverse Origin in a Moderate Tuberculosis Burden Country. PLoS One 2016; 11:e0154803. [PMID: 27148876 PMCID: PMC4858200 DOI: 10.1371/journal.pone.0154803] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/19/2016] [Indexed: 11/19/2022] Open
Abstract
Health care workers (HCW's) are always at an increased risk of contracting tuberculosis (TB) infection. In Saudi Arabia, Interferon Gamma Release Assay (IGRA) has not been evaluated as a screening tool for latent TB infection (LTBI) among HCW's considering their high demographic diversity. During February 2012 to January 2015 a cross sectional study has been conducted in a tertiary care center with maximum demographically diverse staff population in the capital city-Riyadh. After a short interview and consenting, all the candidates were subjected to tuberculin skin test (TST) and QuantiFERON TB gold In-tube test (QFT). A logistic regression analysis was carried out for establishing the associations between putative risk factors and the diagnostic tests. The candidates were classified according to geographical origin and a detailed analysis was conducted on the impact of their origin towards the results of TST and QFT. Of the 1595 candidates enrolled, 90.6% were BCG vaccinated, female (67.9%) and mainly nurses (53.2%). Candidates with high risk of suspected or confirmed TB patient exposure were 56.1% and 76.5% of them had <10 year's work experience. TST positivity was observed in 503 (31.5%) candidates, while QFT was positive among 399 (25%). Majority of the candidates were non-Saudi (83%) and predominantly (52.4%) from Western Pacific region. Concordant results were obtained in 14.2% of positive cases and 57.7% negative cases. The disagreements between the two tests were relatively high (kappa co-efficient-0.312±0.026, p value- <0.00001) as TST positive/QFT negative discordance was 54.8% while TST negative/QFT positive discordance was 15.7%. Age of the candidates, BCG vaccination, and South East Asian origin were associated with TST positivity while Occupational TB exposure and geographical origin of the candidates were associated with QFT positivity. A regular follow up on recently TST converted candidates showed no progression to active TB. The putative factors associated with the discordance were origin of the candidate (p value <0.001), profession (p value-0.001), BCG vaccination (p value-0.001) and occupational TB exposure level (P value-0.001). The study demonstrated high level prevalence of LTBI among the demographically diverse study candidates. The agreement between QFT and TST was poor, thus QFT alone cannot be recommended in our setting for a routine LTBI screening. Origin of the candidates has strong association with the results of TST and QFT. The discordant results particularly TST negative and QFT positive needs more detailed analysis.
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Affiliation(s)
- Sahal Al Hajoj
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- * E-mail:
| | - Bright Varghese
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Alria Datijan
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Shoukri
- National Biotechnology Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ali Alzahrani
- Gulf Centre for Cancer Control and Prevention, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdallah Alkhenizan
- Department of Family Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulaziz AlSaif
- Department of Family Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sahar Althawadi
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Grace Fernandez
- Mycobacteriology Research Section, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdulrahman Alrajhi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Khawcharoenporn T, Apisarnthanarak A, Sangkitporn S, Rudeeaneksin J, Srisungngam S, Bunchoo S, Phetsuksiri B. Tuberculin Skin Test and QuantiFERON(®)-TB Gold In-Tube Test for Diagnosing Latent Tuberculosis Infection among Thai Healthcare Workers. Jpn J Infect Dis 2015; 69:224-30. [PMID: 26255736 DOI: 10.7883/yoken.jjid.2015.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A cross-sectional study was conducted on the performance of the tuberculin skin test (TST) and QuantiFERON(®)-TB Gold In-Tube test (QFT-IT) for detecting latent tuberculosis infection among Thai healthcare workers (HCWs). Each HCW underwent both the TST and QFT-IT during the annual health screening. Among the 260 HCWs enrolled, the median age was 30 years (range 19-60 years), 92% were women, 64% were nurses and nurse assistants, 78% were Bacillus Calmette Guérin vaccinated, and 37% had previously taken the TST. Correlation between TST reaction size and the interferon-γ level was weak (r = 0.29; P < 0.001). Of the HCWs, 38% and 20% had a reactive TST and a positive QFT-IT, respectively. Using QFT-IT positivity as a standard for latent tuberculosis diagnosis, the cut-off for TST reactivity with the best performance was ≥13 mm with a sensitivity, specificity, false positivity, and false negativity of 71%, 70%, 30%, and 29%, respectively (area under the curve 0.73; P < 0.001). The independent factor associated with a false reactive TST was a previous TST (adjusted odds ratio 1.83; P = 0.04). Our findings suggest that the QFT-IT may be the preferred test among HCWs with previous TST. In settings where the QFT-IT is not available, appropriate cut-offs for TST reactivity should be evaluated for use among HCWs.
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Lamberti M, Uccello R, Monaco MGL, Muoio M, Feola D, Sannolo N, Nienhaus A, Chiodini P. Tuberculin skin test and Quantiferon test agreement and influencing factors in tuberculosis screening of healthcare workers: a systematic review and meta-analysis. J Occup Med Toxicol 2015; 10:2. [PMID: 25670962 PMCID: PMC4323208 DOI: 10.1186/s12995-015-0044-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/15/2015] [Indexed: 11/28/2022] Open
Abstract
Objective A systematic review and meta-analysis was conducted to evaluate the agreement between Tuberculin Skin Test (TST) and Quantiferon (QFT) in screening for tuberculosis (TB) infection among healthcare workers (HCWs) and to estimate associations between TST and QFT agreement and variables of interest, such as Bacillus Calmette-Guérin (BCG) vaccination and incidence of TB. Methods Cross-sectional and longitudinal studies on HCWs, published in English until October 2013, comparing TST and QFT results, were selected. For each study Cohen’s κ value and a 95% confidence interval were calculated. Summary measures and indexes of heterogeneity between studies were calculated. Results 29 studies were selected comprising a total of 11,434 HCWs. Cohen’s κ for agreement between TST and QFT for 24 of them was 0.28 (95% CI 0.22 to 0.35), with the best value in high TB incidence countries and the lowest rate of BCG vaccination. Conclusion Currently, there is no gold standard for TB screening and the most-used diagnostic tools show low agreement. For evidence-based health surveillance in HCWs, occupational physicians need to consider a number of factors influencing screening results, such as TB incidence, vaccination status, age and working seniority.
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Affiliation(s)
- Monica Lamberti
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Rossella Uccello
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Maria Grazia Lourdes Monaco
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Mariarosaria Muoio
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Daniela Feola
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Nicola Sannolo
- Department of Experimental Medicine, Section of Hygiene, Occupational Medicine and Forensic, Medicine, Second University of Naples, Naples, Italy
| | - Albert Nienhaus
- Center of Excellence for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Principles of Prevention and Rehabilitation Department (GPR), Institute for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
| | - Paolo Chiodini
- Medical Statistics Unit, Second University of Naples, Naples, Italy
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El-Helaly M, Khan W, El-Saed A, Balkhy HH. Pre-employment screening of latent tuberculosis infection among healthcare workers using tuberculin skin test and QuantiFERON-TB Gold test at a tertiary care hospital in Saudi Arabia. J Infect Public Health 2014; 7:481-8. [PMID: 25194817 DOI: 10.1016/j.jiph.2014.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 06/13/2014] [Accepted: 07/11/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To assess the agreement between the tuberculin skin test (TST) and the QuantiFERON-TB Gold test (QFT-G) as pre-employment screening tests for latent tuberculosis infection (LTBI) among healthcare workers. METHODS A retrospective cross-sectional study was conducted among 1412 healthcare workers who were screened for LTBI during the period from August 2009 to May 2011 at a tertiary-care hospital in the Kingdom of Saudi Arabia (KSA). The studied population was screened for LTBI using both TST and QFT-G simultaneously. The agreement between both tests was quantified using the Kappa coefficient (κ). RESULTS Comparing the results of QFT-G with TST, the tests had a significant overall agreement of 73.7% (1040/1412; κ=0.33; p<0.01). Negative concordance comprised 60.1% of the results, and positive concordance comprised 13.5%. However, positive TST but negative QFT comprised 16.3% of the results, and negative TST but positive QFT-G comprised 10.1%. Concordance was significantly associated with young age, female gender, Saudi-born nationals, and early career but not job type (clinical versus non-clinical) nor status of Bacillus Calmette-Guerin (BCG) vaccination. CONCLUSIONS This study demonstrated 73.7% overall agreement between TST and QFT-G results among healthcare workers during pre-employment screening for LTBI. The results need to be confirmed in future studies before recommending QFT-G as a pre-employment screening test for LTBI.
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Affiliation(s)
- Mohamed El-Helaly
- Infection Prevention and Control Department, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Egypt.
| | - Waseem Khan
- Infection Prevention and Control Department, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Aiman El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Egypt
| | - Hanan H Balkhy
- Infection Prevention and Control Department, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, National Guard Health Affairs, Kingdom of Saudi Arabia
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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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Kim SY, Park MS, Kim YS, Kim SK, Chang J, Yong D, Kim HS, Lee K, Kang YA. Tuberculin skin test and boosted reactions among newly employed healthcare workers: an observational study. PLoS One 2013; 8:e64563. [PMID: 23717631 PMCID: PMC3663761 DOI: 10.1371/journal.pone.0064563] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 04/15/2013] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the prevalence of and factors associated with latent tuberculosis infection (LTBI) based on the tuberculin skin test (TST) and to estimate the boosted reaction rate among newly employed healthcare workers (HCWs). Design Newly employed HCWs between January 2010 and July 2012 at Severance Hospital in South Korea were enrolled in this study. A one-step TST was conducted before October 2011, and a two-step TST after October 2011. Results Of 2132 participants, 778 (36.5%) had positive TST results. Being older (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.06–1.13, P<0.001), male (OR 1.78, 95% CI 1.21–2.62, P = 0.003), rejoining the hospital workforce (OR 1.58, 95% CI 1.04–2.40, P = 0.032), and having a previous history of tuberculosis (TB) (OR 18.21, 95% CI 2.15–154.10, P = 0.008) during the one-step period, and being older (OR 1.15, 95% CI 1.10–1.21, P<0.001) during the two-step period were significantly associated with a positive TST. A two-step TST was performed in 556 HCWs, and a boosted reaction was observed in 79 (14.2%). The induration size on the first TST (5–9-mm group) was the only factor associated with a boosted reaction on the second TST. Conclusions The prevalence of LTBI based on the TST among newly employed HCWs was high. The boosted reaction rate on two-step TST was not low; therefore, the use of two-step TST may be necessary for regular monitoring in countries with an intermediate TB burden and a high rate of Bacillus Calmette-Guérin vaccination.
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Affiliation(s)
- Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Jo KW, Jeon K, Kang YA, Koh WJ, Kim KC, Kim YH, Yoo KH, Lee SH, Yim JJ, Choi SB, Choi WI, Choi JC, Hwang YI, Shim TS. Poor correlation between tuberculin skin tests and interferon-γ assays in close contacts of patients with multidrug-resistant tuberculosis. Respirology 2013; 17:1125-30. [PMID: 22758779 DOI: 10.1111/j.1440-1843.2012.02218.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE The results of tuberculin skin tests (TST) and QuantiFERON TB-Gold In-Tube (QFT-GIT) assays were compared in close contacts of patients with multidrug-resistant tuberculosis (MDR-TB). METHODS Close contacts of patients with bacteriologically confirmed MDR-TB (n = 101) were assessed. Most contacts were members of the households of patients, and 79 (78.2%) had received Bacille Calmette-Guerin (BCG) vaccination. Samples from each contact were tested using the TST and the QFT-GIT assay on the same day, and the concordance between these results was assessed using kappa (κ) coefficients. RESULTS Forty-eight subjects (47.5%) showed positive responses on TST, using a 10-mm induration cut-off, and 54 (53.5%) were positive for the QFT-GIT assay. Of the 48 individuals who were TST positive, 34 (70.8%) were positive for the QFT-GIT assay. Of the 53 subjects who were TST negative, 33 (62.5%) were negative for the QFT-GIT assay. The overall agreement between the two tests (κ coefficient) was 0.33. The κ coefficient was higher in the 22 subjects who had not received BCG vaccination (κ = 0.48) than in the 79 subjects who had received BCG vaccination (κ = 0.29). CONCLUSION The TST and QFT-GIT assays showed poor correlation in close contacts of patients with MDR-TB, especially those contacts who had received BCG vaccination.
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Affiliation(s)
- Kyung-Wook Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-Dong, Songpa-gu, Seoul 138-736, South Korea
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Jung DH, Jo KW, Shim TS. Prevalence of Latent Tuberculosis Infection among Medical Students in South Korea. Tuberc Respir Dis (Seoul) 2012; 73:219-23. [PMID: 23166557 PMCID: PMC3492422 DOI: 10.4046/trd.2012.73.4.219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/08/2012] [Accepted: 09/27/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We investigated the prevalence of latent tuberculosis infection (LTBI) among medical students in South Korea. METHODS Students from one medical school, who were in second- or third-year classes before clerkship course, were enrolled for three consecutive years in the study. A standard questionnaire 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 153 participants were enrolled in the study. The mean age of the subjects was 21.9±0.9 years, 105 (68.6%) were male, and 132 (86.3%) had been vaccinated with Bacille Calmette-Guerin (BCG). Four students (2.6%) had a history of contact with tuberculosis (TB) patients during medical practice. No abnormal chest radiograph findings were found for any of the subjects. Of the 153 subjects, 23 (15.0%) tested positive for the TST, and 8 (5.2%) tested positive for the QFT-GIT. The agreement between the two tests was determined to be 0.34 using kappa coefficients. Of the four students who had a history of contact with TB patients, only one subject tested positive for both tests, and the other three students tested negative for both tests. CONCLUSION A low prevalence of LTBI was found among medical students before clerkship course in South Korea.
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Affiliation(s)
- Da Ho Jung
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim SY, Park MS, Kim YS, Kim SK, Chang J, Kang YA. Conversion rates of an interferon-γ release assay and the tuberculin skin test in the serial monitoring of healthcare workers. Infection 2012; 41:511-6. [PMID: 23104257 DOI: 10.1007/s15010-012-0356-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Regular monitoring of latent tuberculosis (TB) infection in healthcare workers (HCWs) is recommended, but the view about the effective method and performance of serial monitoring is controversial. The aim of this study was to determine differences in conversion rates according to TB exposure risk using the tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-GIT), and to evaluate the reproducibility and within-subject variability of the QFT-GIT in South Korea. METHODS Fifty-three HCWs were grouped according to their risk for TB exposure: group 1, high risk (n = 21); group 2, low risk (n = 32). Baseline and follow-up TSTs and QFT-GITs were performed from June 2009 to July 2011. Enzyme-linked immunosorbent assays (ELISAs) were repeated for the second QFT-GIT and a third QFT-GIT was performed after 8 weeks when discordant results of the second TST and QFT-GIT or a conversion or reversion were observed. RESULTS No difference in the QFT-GIT conversion rate was evident between the two groups (15.4 vs. 6.5 %, p = 0.57), and no TST conversion was observed. The rate of QFT-GIT positivity was higher in the high-risk group (first QFT-GIT: 38.1 vs. 3.1 %, p = 0.002; second QFT-GIT: 33.3 vs. 9.4 %, p = 0.039). The re-test reproducibility of QFT-GIT results was high (100 %), and the within-subject results of repetitive QFT-GITs were variable. CONCLUSIONS Stricter prevention strategies remain necessary in HCWs at high risk of TB exposure, and serial interferon-γ release assays (IGRAs) should be interpreted with caution in HCWs.
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Affiliation(s)
- S Y Kim
- Division of Pulmonology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonseiro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
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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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Song S, Jeon D, Kim JW, Kim YD, Kim SP, Cho JS, Lee SE, Cho WH, Park HK, Kim YS, Lee MK, Lee JH. Performance of confirmatory interferon-γ release assays in school TB outbreaks. Chest 2011; 141:983-988. [PMID: 21980060 DOI: 10.1378/chest.11-1158] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Interferon-γ release assays (IGRAs) have been incorporated into several national guidelines for latent TB infection (LTBI) diagnosis. However, their optimal application is still controversial and evolving. The aim of this study is to evaluate the performance of confirmatory IGRAs in addition to tuberculin skin tests (TSTs) in high school students with TST-positive (TST+) results who have had contact with another student who had TB (referred to in this article as "contacts") in TB outbreaks in a high BCG-vaccinated population. METHODS We conducted a retrospective observational study of contacts in five school TB outbreaks in South Korea. The progression rates of TB within 2 years were compared among the groups based on the results of TSTs and QuantiFERON-TB gold assays (QFT-Gs). RESULTS Among 1,826 contacts, 21 (1.2%) developed active TB. Of the untreated groups, the rate of progression to TB was higher in the group with TST-positive (TST+) results (6.1%, six of 99) than in that with TST-negative (TST-) results (0.6%, 10 of 1,556; P < .001). Among TST+ contacts, the rate of progression to TB was higher in the group with QFT-G-positive (QFT-G+) results (18.75%, six of 32) than that with QFT-G-negative (QFT-G(-)) results (0%, 0 of 67; P = .001). None of the 67 contacts with TST+/QFT-G(-) results progressed to active TB. CONCLUSIONS The addition of a confirmatory IGRA for TST+ contacts could effectively focus the targeting of LTBI treatment to fewer contacts in an intermediate-incidence setting in a high BCG-vaccinated population.
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Affiliation(s)
- Seunghwan Song
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, Busan, Korea
| | - Doosoo Jeon
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Jong Won Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, Busan, Korea
| | - Yeong Dae Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, Busan, Korea
| | - Sang-Pil Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, Busan, Korea
| | - Jeong Su Cho
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Seung Eun Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Woo Hyun Cho
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Hye-Kyung Park
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Yun Seong Kim
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea.
| | - Min Ki Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Ho Lee
- Department of Emergency Medicine, Samsung Changwon Hospital, Changwon, South Korea
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22
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Preemployment screening for tuberculosis in a large health care setting: comparison of the tuberculin skin test and a whole-blood interferon-γ release assay. J Occup Environ Med 2011; 53:290-3. [PMID: 21346634 DOI: 10.1097/jom.0b013e31820c91c5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Determine the performance of an interferon-γ release assay in a health care occupational surveillance program. METHODS From January 11, 2005, through January 31, 2006, all new employees (n = 652) undergoing standard, preemployment evaluation at Mayo Clinic, Rochester, Minnesota were evaluated for tuberculosis using a standard process of symptom screening combined with tuberculin skin test (TST) and QuantiFERON-TB Gold test (QFT-G). RESULTS Comparing the results of QFT-G directly to TST, QFT-G showed an overall agreement of 92.5%. CONCLUSIONS False-positive TST were the most significant issue affecting agreement, and in a low-tuberculosis prevalence population, the need for an effective strategy offering low false-positive results may be best met by combining the TST with QFT-G.
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Cho OH, Park KH, Park SJ, Kim SM, Park SY, Moon SM, Chong YP, Kim MN, Lee SO, Choi SH, Woo JH, Kim YS, Kim SH. Rapid diagnosis of tuberculous peritonitis by T cell-based assays on peripheral blood and peritoneal fluid mononuclear cells. J Infect 2011; 62:462-71. [DOI: 10.1016/j.jinf.2011.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 03/28/2011] [Accepted: 04/01/2011] [Indexed: 11/16/2022]
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