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d’Ettorre G, Karaj S, Piscitelli P, Maiorano O, Attanasi C, Tornese R, Carluccio E, Giannuzzi P, Greco E, Ceccarelli G, d’Ettorre G, Lobreglio G, Congedo P, Broccolo F, Miani A. Right to Occupational Safety: Prevalence of Latent Tuberculosis Infection in Healthcare Workers. A 1-Year Retrospective Survey Carried out at Hospital of Lecce (Italy). EPIDEMIOLOGIA 2023; 4:454-463. [PMID: 37987310 PMCID: PMC10660459 DOI: 10.3390/epidemiologia4040038] [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: 10/02/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Prevention of latent tuberculosis infection (LTBI) in healthcare workers (HCWs) to ensure the "Right to Occupational Safety" is a special challenge globally, as HCWs have a higher risk of acquiring the infection in hospital settings because of frequent close exposure to patients suffering from tuberculosis (TB). METHODS Aretrospective study was performed with the aim of assessing the prevalence of LTBI related to demographical and occupational risk factors among HCWs employed in a large hospital in Italy. The study involved 1461 HCWs screened for LTBI by Mantoux tuberculin skin test (TST) and then confirmed with Interferon Gamma Release Assay (IGRA) test in case of positivity. Immunosuppressed and BGC-vaccinated workers were tested directly with IGRA. RESULTS LTBI was diagnosed in 4.1% of the HCWs and the prevalence resulted lower than other studies conducted in low TB incidence countries. The variables significantly linked with higher frequency of the infection were: age ≥40 years (OR = 3.14; 95% CI: 1.13-8.74; p < 0.05), length of service ≥15 years (OR = 4.11; 95% CI: 1.48-11.43; p < 0.05) and not being trained on TB prevention (OR = 3.46; 95% CI: 1.85-6.46; p < 0.05). Not trained HCWs presented a higher risk of LTBI also after adjustment for age and length of service, compared to trained HCWs. CONCLUSIONS screening of HCWs for LTBI should be always considered in routinely occupational surveillance in order to early diagnose the infection and prevent its progression. Safety policies in hospital settings centered on workers' training on TB prevention is crucial to minimize LTBI occurrence in HCWs.
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Affiliation(s)
- Gabriele d’Ettorre
- Vito Fazzi Hospital, Local Health Authority ASL Le, 73100 Lecce, Italy; (G.d.); (O.M.); (C.A.); (R.T.); (E.C.); (P.G.); (G.L.); (P.C.)
| | - Stela Karaj
- Faculty of Social Sciences, European University of Tirana, 1000 Tirana, Albania;
| | - Prisco Piscitelli
- Vito Fazzi Hospital, Local Health Authority ASL Le, 73100 Lecce, Italy; (G.d.); (O.M.); (C.A.); (R.T.); (E.C.); (P.G.); (G.L.); (P.C.)
- Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy;
- Italian Society of Environmental Medicine, 20123 Milan, Italy; (E.G.); (A.M.)
| | - Osvaldo Maiorano
- Vito Fazzi Hospital, Local Health Authority ASL Le, 73100 Lecce, Italy; (G.d.); (O.M.); (C.A.); (R.T.); (E.C.); (P.G.); (G.L.); (P.C.)
| | - Carmen Attanasi
- Vito Fazzi Hospital, Local Health Authority ASL Le, 73100 Lecce, Italy; (G.d.); (O.M.); (C.A.); (R.T.); (E.C.); (P.G.); (G.L.); (P.C.)
| | - Roberta Tornese
- Vito Fazzi Hospital, Local Health Authority ASL Le, 73100 Lecce, Italy; (G.d.); (O.M.); (C.A.); (R.T.); (E.C.); (P.G.); (G.L.); (P.C.)
| | - Eugenia Carluccio
- Vito Fazzi Hospital, Local Health Authority ASL Le, 73100 Lecce, Italy; (G.d.); (O.M.); (C.A.); (R.T.); (E.C.); (P.G.); (G.L.); (P.C.)
| | - Paolo Giannuzzi
- Vito Fazzi Hospital, Local Health Authority ASL Le, 73100 Lecce, Italy; (G.d.); (O.M.); (C.A.); (R.T.); (E.C.); (P.G.); (G.L.); (P.C.)
| | - Enrico Greco
- Italian Society of Environmental Medicine, 20123 Milan, Italy; (E.G.); (A.M.)
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (G.d.)
| | - Gabriella d’Ettorre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (G.C.); (G.d.)
| | - Giambattista Lobreglio
- Vito Fazzi Hospital, Local Health Authority ASL Le, 73100 Lecce, Italy; (G.d.); (O.M.); (C.A.); (R.T.); (E.C.); (P.G.); (G.L.); (P.C.)
| | - Pierpaolo Congedo
- Vito Fazzi Hospital, Local Health Authority ASL Le, 73100 Lecce, Italy; (G.d.); (O.M.); (C.A.); (R.T.); (E.C.); (P.G.); (G.L.); (P.C.)
| | - Francesco Broccolo
- Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy;
| | - Alessandro Miani
- Italian Society of Environmental Medicine, 20123 Milan, Italy; (E.G.); (A.M.)
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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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Szturmowicz M, Broniarek-Samson B, Demkow U. Prevalence and risk factors for latent tuberculosis in polish healthcare workers: the comparison of tuberculin skin test and interferon-gamma release assay (IGRA) performance. J Occup Med Toxicol 2021; 16:38. [PMID: 34470622 PMCID: PMC8411527 DOI: 10.1186/s12995-021-00326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Tuberculosis (TB) is still one of the most common infectious diseases worldwide. Health care workers (HCW) are at particular risk of the disease due to their constant exposure to TB patients or their specimens, nevertheless no specific surveillance is widely recommended in this group of professionals. Both, tuberculin skin test (TST) and interferon-gamma-release-assays (IGRAs) are widely applied to detect latent tuberculosis infection (LTBI). The aim of the present study was to evaluate the prevalence and risks of LTBI in the population of Polish HCW, to identify factors associated with LTBI, as well as to determine the rate of the discordance between the results of the two applied tests in relation to various factors in a TB endemic setting. The study participants were recruited from several health care facilities (hospitals and outpatients clinics) all over the country. Laboratory personnel included 156 persons from both TB and non-TB laboratories (118 clinical pathologists, 38 laboratory technicians), 31 medical doctors, 29 nurses (from both TB and non-TB wards and from family practices), 6 other medical employees (patients assistants). Out of examined group 88 (40%) declared constant (everyday) occupational contact with TB patients and/or contagious biologic materials, 134 (60%) reported sporadic (incidental) contact (few times a year). Administrative HCWs who were not in direct contact with patients were not included in the study group. Material and methods LTBI status was prospectively evaluated in 222 HCW, 204 females, 18 males, aged 40.8 ± 9 years, with tuberculin skin test (TST) and interferon gamma release assay (QuantiFERON-TB-Gold in Tube – QFT GIT). Results TST ≥ 10 mm was found in 58% of HCW, QFT GIT ≥ 0.35 IU/ml in 23%. Nevertheless the relative number of positive QFT GIT in HCW above 45 years of age exceeded those obtained in general population (prevalence of positive QTF test in polish adult population is around 23%). The risk of obtaining positive QFT GIT was significantly increased in the participants older than 44 years (OR = 4.95, 95%CI:2.375–10.193), in those employed > 10 years (OR = 2.726, 95%CI:1.126–6.599), and in those who reported the direct contact with tuberculous patients or infected biological materials (OR = 8.135, 95%CI:1.297–51.016). The concordance between TST and IGRA was poor (kappa 0.23), especially in younger participants, possibly due to BCG vaccination in childhood. Conclusion The increased risk of LTBI in Polish HCW was related to age, duration of employment and contact with infectious patients or their biological specimens. TB infection control measures in health care facilities in Poland are still insufficient. It is crucial to increase awareness about the importance of detecting and treating LTBI of HCW.
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Affiliation(s)
- Monika Szturmowicz
- 1st Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | | | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland.
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Son E, Jeon D. Current situation of tuberculosis and National Strategic Plan for Tuberculosis Control in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.4.316] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tuberculosis (TB) remains a serious public health problem in Korea. Korea has the highest incidence rate (59 per 100,000 population) and the second-highest TB mortality rate (four per 100,000 population) among Organisation for Economic Cooperation and Development member countries. However, some progress has been made in TB control over the past decade. The notification rate of new TB cases has been gradually decreasing since reaching its highest rate in 2011 (78.9 per 100,000 population). In 2019, the notification rate of new TB cases was 46.4 per 100,000 population, with a reduction of 9.9% from the 2018 rate. Additionally, the number of multidrug-resistant TB cases decreased from 618 in 2018 to 580 in 2019. This progress is thought the result of various TB control programs including a TB public–private mix model, insurance coverage for TB management, and a contact investigation program. Despite the progress made, new challenges have also emerged. The predominant challenges lie in the relatively increasing burden of TB in the vulnerable population (aging, socio-economically vulnerable, and foreign-born population), the implementation of latent TB infection management, and the high rate of multidrug-resistant TB. Since 2019, the Korean government has been implementing the “Midterm strategies to strengthen TB prevention and management” based on the 2nd National Strategic Plan for Tuberculosis Control (2018-2022). This program will be a turning point of TB control in Korea. The results produced in 2023 is expected to be favorable.
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Choi YR, Lee JK, Heo EY, Kim DK, Jin KN. Chest Radiographs and CT Findings during Healthcare Workers' Tuberculosis Screening Using Interferon-Gamma Release Assay: Retrospective Observational Study. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1524-1533. [PMID: 36238873 PMCID: PMC9431965 DOI: 10.3348/jksr.2020.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/18/2020] [Accepted: 03/03/2021] [Indexed: 11/15/2022]
Abstract
Purpose To investigate the incidence of tuberculosis (TB) in healthcare workers (HCWs) with positive interferon-gamma release assay (IGRA) results based on chest X-ray (CXR) and CT findings and determine the role of imaging in the diagnosis of TB. Materials and Methods Among 1976 hospital personnel screened for TB using IGRA, IGRA-positive subjects were retrospectively investigated. Clustered nodular and/or linear streaky opacities in the upper lung zone were considered positive on CXR. The CT findings were classified as active, indeterminate, inactive, or normal. The active or indeterminate class was considered CT-positive. Results IGRA was positive in 255 subjects (12.9%). CXR and CT were performed in 249 (99.2%) and 113 subjects (45.0%), respectively. CXR- and CT-positive findings were found in 7 of 249 (2.8%) and 9 of 113 (8.0%) patients, respectively. Among the nine CT-positive subjects, active and indeterminate TB findings were found in 6 (5.3%) and 3 (2.7%) patients, respectively. Microbiological tests, including acid-fast bacilli staining, culture, and polymerase chain reaction for TB, were negative in all nine CT-positive subjects. Empirical anti-TB medications were administered to 9 CT-positive subjects, and 3 of these nine subjects were CXR-negative for pulmonary TB. Conclusion CT helped diagnose asymptomatic TB in IGRA-positive HCWs.
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Affiliation(s)
- Ye Ra Choi
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Kyu Lee
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Wardani HR, Mertaniasih NM, Soedarsono S. RISK FACTORS OF LATENT TUBERCULOSIS INFECTION IN HEALTHCARE WORKERS AT HOSPITALS IN JEMBER CITY INDONESIA. Afr J Infect Dis 2020; 15:34-40. [PMID: 33884356 PMCID: PMC8047285 DOI: 10.21010/ajid.v15i1.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Healthcare workers in Tuberculosis (TB) and non-TB units in hospitals have a high risk of experiencing Latent Tuberculosis Infection (LTBI), because of exposure to droplets containing Mycobacterium tuberculosis. This study aims to prove LTBI incidence and risk factors to healthcare workers at the hospital in Jember City. Material and Methods: a cross-sectional study, from January to March 2020 in two hospitals in Jember City. Healthcare workers in the TB care and non-TB care unit were examined using Tuberculin skin test (TST) with a cut off ≥ 10 mm for positive LTBI. Chest x-ray and clinical examination to rule out active TB and a standardized questionnaire were also used. Results: 128 healthcare workers completed the questionnaires, clinical, tuberculin skin test (TST), and chest x-ray data. LTBI incidence of positive results 61.7% (n = 79). Contacts TB in the workplace (p value = 0.219; OR = 1.643; CI = 0.742-3.641) and a unit of work (p value = 0.102; OR = 0.760; CI = 0.559-1.031) has no relationship with LTBI. The profession (p value = 0.020; OR = 1.112; CI = 0.896-1.403), the duration of the work (p value = 0.039; OR = 2.984; CI = 1.067-8.342), and BCG immunization (p value =0.000; OR = 0.151; CI = 0.052-0.438) have important relationships with LTBI. Conclusion: TB infection with a high incidence, a risk of transmission to healthcare workers, and a relationship between occupational risk factors and LTBI among healthcare workers in Jember City, Indonesia have been established in this study.
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Affiliation(s)
- Hamidah Retno Wardani
- Student of Master Program of Tropical Medicine, Faculty of Medicine, Universitas Airlangga, Jl. Mayjen. Prof. Dr. Moestopo No. 47, Surabaya 60131, Indonesia
| | - Ni Made Mertaniasih
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Jl. Mayjen. Prof. Dr. Moestopo No. 47, Surabaya 60131, Indonesia
| | - Soedarsono Soedarsono
- Department of Pulmonology, Faculty of Medicine, Universitas Airlangga-Dr. Soetomo Hospital, Jl. Mayjen. Prof. Dr. Moestopo No. 47, Surabaya 60131, Indonesia
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Frequency of and risk factors for reversion of QuantiFERON test in healthcare workers in an intermediate-tuberculosis-burden country. Clin Microbiol Infect 2020; 27:1120-1123. [PMID: 32971252 DOI: 10.1016/j.cmi.2020.09.016] [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: 04/16/2020] [Revised: 08/19/2020] [Accepted: 09/08/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES High-risk healthcare workers (HCWs) are often screened for latent tuberculosis infection (LTBI) using QuantiFERON tests (QFTs), with annual serial tests often showing reversion from positive to negative results. We assessed the frequency of and risk factors for reversion of QFTs in HCWs in an intermediate-tuberculosis burden country. METHODS We enrolled high-risk HCWs at a tertiary-care hospital in South Korea, who were assessed by QFTs at least twice between 2017 and 2019. RESULTS Of the 1870 HCWs screened, 1542 (82%) had persistent negative results, 229 (12%) had persistent positive results, 53 (3%) showed reversion, and 46 (2%) showed conversion from negative to positive. Multivariate analysis comparing the characteristics of the 229 HCWs with persistent positive results and the 53 who experienced reversion showed that older age (adjusted odds ratio (aOR): 0.96; 95% confidence interval (CI): 0.92-0.99), male sex (aOR: 0.29; 95% CI: 0.11-0.78) and high (≥0.70 IU/mL) baseline QFT results (aOR: 0.15; 95% CI: 0.07-0.31) were inversely associated with reversion. Using an ROC curve-derived cut-off of <0.738 IU/mL, the area under the curve was 0.79. Of 53 HCWs with reversion, 36 (78%) had below 0.738 IU/mL of baseline QFT, while 181 (79%) of 229 HCWs without reversion had above 0.738 IU/mL of baseline QFT. CONCLUSION Reversion during serial testing is unlikely in HCWs who are male, older in age, and have higher baseline QFT results. Serial testing without LTBI treatment may be indicated in HCWs who are female, younger and, especially, have lower QFT results.
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Comparison of Latent Tuberculosis Infections among General versus Tuberculosis Health Care Workers in Myanmar. Trop Med Infect Dis 2020; 5:tropicalmed5030116. [PMID: 32674505 PMCID: PMC7559984 DOI: 10.3390/tropicalmed5030116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
Health care workers (HCWs) in high tuberculosis (TB) prevalence countries have to care for many cases, thus increasing their risk of infection. The objective of the study was to compare the prevalence of latent TB infection (LTBI) between general HCWs and TB HCWs, and also to explore the associated factors. A cross-sectional study was conducted in Nay Pyi Taw, Myanmar from September 2019 to January 2020. Staff working at two general hospitals were recruited. Those allocated for TB care were classified as TB HCWs, while the remaining were classified as general HCWs. Participants were interviewed using a structured questionnaire, and screened for LTBI using a tuberculin skin test (TST). Individuals who had an induration of 10 mm or more with normal chest radiograph were regarded as having LTBI. The prevalence of LTBI among general HCWs was 2.04 times higher than that of TB HCWs (31.2% vs. 15.3%, p < 0.001). The associated factors for LTBI included low education level, duration of work experience ≥ 10 years, a low knowledge of regular TB screening, and teaching cough etiquette to TB patients. The higher prevalence of LTBI in the general HCWs in this study was due to confounding by education and experience. After adjustment for these, we have no evidence to support that either group of HCWs had higher LTBI risk.
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Park JH, Kim N, Park H, Kim TS, Park SW, Roh EY, Yoon JH, Shin S. The use of a borderline zone for the interpretation of interferon-gamma release assay results for serial screening of healthcare workers. PLoS One 2020; 15:e0235254. [PMID: 32603343 PMCID: PMC7326217 DOI: 10.1371/journal.pone.0235254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/01/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE An interferon-gamma release assay (IGRA) is used to screen for latent tuberculosis infection (LTBI). Among IGRAs, the QuantiFERON-TB Gold In-Tube (QFT-GIT) results are highly variable, so the borderline zone has been proposed to reduce unnecessary LTBI treatment. The aim of this study was to examine the proportion of the borderline zone of QFT-GIT in healthcare workers' (HCWs) serial IGRA and to retrospectively identify the utility of predicting tuberculosis (TB) in a moderate TB incidence setting. METHODS The participants were HCWs who had undergone serial LTBI screening between June 2013 and June 2018. IGRA-positive HCWs underwent examinations that included low-dose computed tomography (LDCT) and TB culture, if necessary. Applying the borderline zone (0.2-<0.7 IU/mL), the results were classified as definite negative, borderline negative, borderline positive and definite positive. RESULTS Through the follow-up of 477 HCWs, 441 (92.5%) invariant, 30 (6.3%) conversion, 2 (0.4%) reversion and 5 (1.0%) indeterminate results were observed with the manufacturer's cutoff. Applying the borderline zone, 419 (87.8%) invariant, 22 (4.6%) conversion, 1 (0.2%) reversion and 36 (7.5%) decision pending, including 5 (1.0%) indeterminate results, were observed. At the time of screening, five TB cases were identified. Chest X-ray (CXR) identified one TB case, and LDCT identified four additional TB cases. After one year, two TB cases were diagnosed, and their screening QFT-GIT results were definite positive and borderline negative. In the Cochran-Armitage trend test, the greater the maximum difference in the QFT-GIT grade with the borderline zone was, the higher the probability of developing TB (P-value <0.001). CONCLUSION The application of the borderline zone lowered the conversion rate but increased the decision pending rate. Introducing the borderline zone requires a careful approach, and a thorough examination needs to be performed to rule out TB in converters. HCWs with borderline QFT-GIT results also need close observation.
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Affiliation(s)
- Jae Hyeon Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Namhee Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hyunwoong Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Taek Soo Kim
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Eun Youn Roh
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jong Hyun Yoon
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sue Shin
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
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Chia SZG, How KBM, Chlebicki MP, Ling ML, Gan WH. A retrospective review of tuberculosis exposure among health care workers in a tertiary hospital. Am J Infect Control 2020; 48:650-655. [PMID: 31806237 PMCID: PMC7132713 DOI: 10.1016/j.ajic.2019.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/26/2022]
Abstract
he baseline prevalence of Latent Tuberculosis Infection (LTBI) among Healthcare workers screened for Tuberculosis exposure was 14.6%. Age above 40 years, non-Chinese ethnicity, and foreign nationality were associated with baseline LTBI. Only 2.5% of all healthcare workers screened for tuberculosis exposure experienced QFT-GIT conversion resulting in an incidence rate of 1.14 cases per 100 exposure episodes per year. Healthcare workers with more episodes of TB exposure are also more likely to develop post exposure LTBI.
Background We evaluated tuberculosis (TB) acquisition rate and risk factors among health care workers (HCWs) exposed to index TB patients. Methods We performed a retrospective cohort study on exposed HCWs from August 2016 to January 2018 at a tertiary hospital in Singapore. Demographic factors and TB exposure episodes per HCW were obtained. A modified Poisson regression model was used to identify factors associated with TB infection. Results A total of 32 TB exposure events occurred during the study period. A total of 881 HCWs with 1,536 exposure episodes were screened with QuantiFERON-TB Gold In-tube assay (QFT-GIT) at baseline and 8 weeks. A total of 129 (14.6%) HCWs had positive QFT-TB at baseline, whereas 22 (2.5%) HCWs had QFT-GIT conversion, with a latent TB infection (LTBI) rate of 1.14 cases per 100 exposure episodes per year. Foreign nationality, non-Chinese ethnicity, and age above 40 years were independently associated with baseline LTBI, whereas having >2 TB exposure episodes and working in internal medicine, medical subspecialties, and psychiatry wards were associated with QFT-GIT conversion. Discussion The QFT-GIT conversion rate among screened HCWs is low. Foreign HCWs with LTBI likely came from countries with higher TB transmission. Targeted prevention of repeated TB exposures can reduce QFT-GIT conversion. Conclusions The study results will guide TB contact tracing protocols in health care institutions.
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Affiliation(s)
- Shi Zhe Gabriel Chia
- Occupational and Environmental Medicine Department, Singapore General Hospital, Bukit Merah, Singapore.
| | - Kue Bien Molly How
- Occupational and Environmental Medicine Department, Singapore General Hospital, Bukit Merah, Singapore
| | - Maciej Piotr Chlebicki
- Occupational and Environmental Medicine Department, Singapore General Hospital, Bukit Merah, Singapore
| | - Moi Lin Ling
- Occupational and Environmental Medicine Department, Singapore General Hospital, Bukit Merah, Singapore
| | - Wee Hoe Gan
- Occupational and Environmental Medicine Department, Singapore General Hospital, Bukit Merah, Singapore
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Chung SJ, Lee H, Koo GW, Min JH, Yeo Y, Park DW, Park TS, Moon JY, Kim SH, Kim TH, Sohn JW, Yoon HJ. Adherence to nine-month isoniazid for latent tuberculosis infection in healthcare workers: a prospective study in a tertiary hospital. Sci Rep 2020; 10:6462. [PMID: 32296096 PMCID: PMC7160120 DOI: 10.1038/s41598-020-63156-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/19/2020] [Indexed: 01/07/2023] Open
Abstract
Poor adherence to medication can lead to treatment failure in healthcare workers (HWCs) with latent tuberculosis infection (LTBI) who are at high risk of developing active tuberculosis. However, the factors associated with non-completion of nine-month LTBI treatment with isoniazid (9 H) have not been well studied. We investigated the completion rate and factors affecting adherence to LTBI treatment with 9 H among HCWs. A prospective cohort study of 114 HCWs who were diagnosed with LTBI by QuantiFERON-TB Gold In-Tube tests were performed in a single university hospital between June 2016 and December 2017. All patients received the 9 H LTBI treatment. At each visit, treatment adherence and development of adverse reactions to isoniazid were evaluated via a standard questionnaire. To evaluate the impact of the severity of hepatotoxicity on non-completion of LTBI treatment, we classified hepatotoxicity into two groups: severe hepatotoxicity was defined as alanine aminotransferase >3.0 times the upper normal limit (UNL) with symptoms or = 5.0 times the UNL. Mild hepatotoxicity was defined as alanine aminotransferase>UNL, but not meet the definition of severe hepatotoxicity. Overall, 71 HCWs (62.3%) completed LTBI treatment with 9 H while 43 HCWs (37.7%) discontinued their treatment. Most discontinuation (81.4%, 35/43) occurred during the first three months of treatment. There were no significant differences in age, sex, occupation, or comorbidities between the HCWs who completed and those who discontinued LTBI treatment. However, HCWs who discontinued LTBI treatment had more hepatotoxicity than those who completed treatment (44.2% vs. 11.3%, P < 0.001). Cox proportional hazard analysis revealed that hepatotoxicity is the only factor significantly associated with discontinuation of 9 H LTBI treatment (unadjusted HR = 2.89, 95% CI = 1.62–5.46). In multivariable analysis, not only severe hepatotoxicity (adjusted HR = 7.99, 95% CI = 3.05–20.94) but also mild hepatotoxicity was significantly associated with discontinuation of LTBI treatment (adjusted HR = 2.34, 95% CI = 1.05–5.21). The completion rate of 9 H LTBI treatment was 62.3% among HCWs. While age, sex, occupation, and pretreatment comorbidities were not associated with treatment completion, isoniazid-induced hepatotoxicity significantly affected adherence.
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Affiliation(s)
- Sung Jun Chung
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - 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
| | - Yoomi Yeo
- 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
| | - Tai Sun 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
| | - Jang Won Sohn
- 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
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12
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Jeon D. Latent tuberculosis infection: recent progress and challenges in South Korea. Korean J Intern Med 2020; 35:269-275. [PMID: 32131570 PMCID: PMC7061001 DOI: 10.3904/kjim.2020.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
Management of latent tuberculosis infection (LTBI) is a critical element in the elimination of tuberculosis (TB). However, the low positive predictive value of the current diagnostic tests and the low acceptance and completion rate of the isoniazid- based regimen are major barriers to the implementation and scale-up of programmatic management of LTBI. In the past decade, there has been some progress in the conception, diagnosis, and treatment of LTBI. LTBI is now understood as a dynamic spectrum rather than the traditional binary distinction between active and latent TB. New insight into LTBI has led to a renewed interest in incipient TB, which would be a potential target for developing new diagnostics and therapeutics of LTBI. Recent studies showed that host transcriptomic signatures could be a potential biomarker for incipient TB. The new shorter rifamycin-based regimens have shown comparable efficacy, but better completion rate and safety compared to the isoniazid-based regimen. In South Korea, LTBI management has been expanded and integrated into key elements of the National Tuberculosis Control Program. For the programmatic approach to LTBI management, the following challenges need to be addressed; target group selection, treatment-related interventions, monitoring and surveillance system, and extending the plan for vulnerable groups.
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Affiliation(s)
- Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Correspondence to Doosoo Jeon, M.D. Department of Internal Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-55-360-1414 Fax: +82-55-360-1757 E-mail:
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13
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Min J, Kim HW, Stagg HR, Lipman M, Rangaka MX, Myong JP, Yim HW, Lim JU, Lee Y, Koo HK, Lee SS, Park JS, Cho KS, Kim JS. Latent tuberculosis infection screening and treatment in congregate settings (TB FREE COREA): protocol for a prospective observational study in Korea. BMJ Open 2020; 10:e034098. [PMID: 32075836 PMCID: PMC7045012 DOI: 10.1136/bmjopen-2019-034098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION South Korea regards tuberculosis (TB) incidence in congregate settings as a serious problem. To this end, systematic latent TB infection (LTBI) diagnosis and treatment were provided to approximately 1.2 million individuals in high-risk congregate settings. METHODS AND ANALYSIS We designed a prospective cohort study of individuals tested for LTBI, based on the data collected on all persons screened for LTBI as part of the 2017 congregate settings programme in South Korea. Four types of databases are kept: LTBI screening database (personal information and LTBI test results), national health information (NHI) database (socio-demographic data and comorbidities), public healthcare information system (PHIS) database, and the Korean national TB surveillance system database (TB outcomes). Information regarding LTBI treatment at private hospitals and public health centres is collected from NHI and PHIS databases, respectively. The screening data are cleaned, duplicates are removed, and, where appropriate, re-coded to analyse specific exposures and outcomes. The primary objective is to compare the number of active TB cases prevented within 2 years between participants undergoing treatment and not undergoing treatment in the LTBI screening programme in congregate settings. Cascade of care for LTBI diagnosis and treatment will be evaluated among those with a positive LTBI test result. A Cox proportional hazards model will be applied to determine the risk factors for developing active TB. ETHICS AND DISSEMINATION The protocol is approved by the institutional review boards of Incheon St. Mary's Hospital, the Catholic University of Korea. Study results will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER KCT0003905.
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Affiliation(s)
- Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (the Republic of)
| | - Hyung Woo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Helen R Stagg
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Edinburgh, United Kingdom
| | - Marc Lipman
- Royal Free London NHS Foundation Trust, London, London, United Kingdom
- UCL-TB, University College London, London, United Kingdom
- UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Molebogeng X Rangaka
- Institute for Global Health, University College London, London, London, United Kingdom
| | - Jun-Pyo Myong
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (the Republic of)
| | - Hyeon Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea (the Republic of)
| | - Jeong Uk Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (the Republic of)
| | - Yunhee Lee
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (the Republic of)
| | - Hyeon-Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea (the Republic of)
| | - Sung-Soon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea (the Republic of)
| | - Jae Seuk Park
- Division of Pulmonary Medicine, Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, Korea (the Republic of)
| | - Kyung Sook Cho
- Division of Social Service Projects, Office for Social Welfare Policy, Korea Ministry of Health and Welfare, Sejong, Sejong, Korea (the Republic of)
| | - Ju Sang Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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14
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Aksornchindarat W, Yodpinij N, Phetsuksiri B, Srisungngam S, Rudeeaneksin J, Bunchoo S, Klayut W, Sangkitporn S, Khawcharoenporn T. T-SPOT®.TB test and clinical risk scoring for diagnosis of latent tuberculosis infection among Thai healthcare workers. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 54:305-311. [PMID: 31221513 DOI: 10.1016/j.jmii.2019.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/29/2019] [Accepted: 04/26/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Screening for latent tuberculosis infection (LTBI) is important to identify healthcare workers (HCWs) benefiting from preventive therapy. Interferon-gamma release assays (IGRAs) are sensitive and specific tests for LTBI diagnosis. However, in settings where IGRAs are not available, clinical risk assessment may be used as an alternative to diagnose LTBI. METHODS A cross-sectional study was conducted among HCWs of a tertiary-care university hospital in Thailand. All HCWs underwent T-SPOT®.TB test (T-SPOT) and assessment of LTBI clinical risks. Clinical risks associated with T-SPOT positivity were determined by multivariable logistic regression analysis and were given scores accordingly. The performance of the clinical risk scoring was evaluated in comparison to T-SPOT. RESULTS Among 140 enrolled HCWs, 125 (89%) were females, the median age was 27 years and 23 (16%) had T-SPOT positivity. Independent factors associated with T-SPOT positivity were age ≥30 years (adjusted odds ratio [aOR] 3.95; P = 0.002), working duration ≥60 months (aOR 3.75, P = 0.004) and frequency of TB contact ≥6 times (aOR 8.83, P = 0.005). The study's clinical risk scoring had the area under the curve by receiver operating curve analysis of 0.76 (P < 0.001) using T-SPOT positivity as a reference standard. The score of ≥3 had the best performance in diagnosing LTBI with sensitivity, specificity, positive predictive value and negative predictive value of 70%, 71%, 32% and 92%, respectively. CONCLUSIONS In this setting where LTBI was prevalent among HCWs but IGRAs are not widely available, the clinical risk scoring may be used as an alternative to diagnose LTBI in HCWs.
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Affiliation(s)
| | - Napat Yodpinij
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Benjawan Phetsuksiri
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Sopa Srisungngam
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Janisara Rudeeaneksin
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Supranee Bunchoo
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Wiphat Klayut
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Somchai Sangkitporn
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi, Thailand
| | - Thana Khawcharoenporn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
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15
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Yoon CG, Kang DY, Jung J, Oh SY, Lee JB, Kim MH, Seo Y, Kim HJ. The Infectivity of Pulmonary Tuberculosis in Korean Army Units: Evidence from Outbreak Investigations. Tuberc Respir Dis (Seoul) 2019; 82:298-305. [PMID: 31172703 PMCID: PMC6778738 DOI: 10.4046/trd.2018.0077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/24/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculosis (TB) causes substantial health burden to the Korean military. This study aims to assess the impact of infectious TB cases on close and casual contacts in the Korean Army settings based on contact investigation data. Methods Six Army units with infectious TB cases from September 2012 to May 2013 were enrolled in the study. We analyzed the clinical data from close and casual contacts screened using the tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube to identify latent tuberculosis infection (LTBI) cases. For the control group, 286 military conscripts with no reported TB exposure were tested by TST only. Results Of the 667 contacts of index cases, LTBI cases identified were as follows: 21.8% of close contacts of smear-positive cases (71/326), 8.5% of casual contacts of smear-positive cases (26/305), and 2.8% of close contacts of smear-negative cases (1/36). In the control group, 16.8% showed positivity in TST. In a multivariate analysis, having stayed in the same room or next room with TB patients was identified as a risk factor of LTBI. Conclusion Using the data from TB contact investigations in the Korean Army units, we found an overall LTBI rate of 14.7% among the contacts screened. This study demonstrates that contacts living in the same building, especially the same room or next room, with TB patients are at a high risk of acquiring LTBI, serving as additional evidence for defining close and casual contacts of a TB patient with regard to Army barrack settings.
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Affiliation(s)
- Chang Gyo Yoon
- Department of Preventive Medicine, Armed Forces Medical Command, Seongnam, Korea.,Preventive Medicine Program, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Dong Yoon Kang
- International Peace Supporting Standby Force, Ministry of National Defense, Seoul, Korea.,Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.,Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Armed Forces Medical Command, Seongnam, Korea.,Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soo Yon Oh
- Korean Institute of Tuberculosis, Seoul, Korea
| | | | - Mi Hyun Kim
- Korean Institute of Tuberculosis, Seoul, Korea
| | - Younsuk Seo
- Korean Institute of Tuberculosis, Seoul, Korea
| | - Hee Jin Kim
- Korean Institute of Tuberculosis, Seoul, Korea.
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16
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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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