[Latent Tuberculosis Infection (LTBI) among Medical Personnel after Foreign Assignments]

INTRODUCTION

 Every year, medical personnel are sent abroad via relief organisations in order to provide humanitarian aid. The areas they are sent to are often countries with a high incidence of tuberculosis. The prevalence of latent tuberculosis infections (LTBI) and associated risk factors among returnees in Germany have not yet been systematically investigated.

METHODS

 In a cross-sectional study (N = 95), medical personnel in Germany who had completed at least one foreign assignment were tested for LTBI with the Interferon-Gamma Release Assay in order to examine the LTBI prevalence among them. Relevant risk factors were assessed using a questionnaire. Statistical evaluation was carried out using cross-tables and multiple logistic regression.

RESULTS

 The LTBI prevalence in our sample was 12.63 %, 95 %CI (7.70 %; 23.89 %). The odds of LTBI increased with age (OR = 1.06, 95 %CI [1.01; 1.12], p-value = 0.021, per one life-year) and length of stay abroad (OR = 1.11, 95 %CI [1.03; 1.21], p-value = 0.009, per month).

DISCUSSION

 The study showed a higher LTBI prevalence among returnees after assignments abroad than among medical personnel in Germany after TB contact who had been investigated in previous studies. In order to be able to detect LTBI infections acquired abroad, routine testing before and after an assignment abroad seems to be necessary.

[Psychosocial burden and strains in geriatric nursing: comparison of nursing personnel with and without migration background]

BACKGROUND

Because of demographic changes the nursing care sector is faced with a lack of qualified employees in the medium and long term. The shortage in the work force is caused by high workloads and unfavorable working conditions. In response to this shortage, there have been attempts to recruit qualified nursing staff from abroad and also to improve the integration of people with a migration background living in Germany into the job market.

METHODOLOGY

Based on a quantitative cross-sectional study of 366 nurses, the psychosocial burden and strains among employees with a migration background (n = 112) and without a migration background (n = 254) were examined. For this purpose, 13 scales of the German version of the Copenhagen Psychosocial Questionnaire (COPSOQ) were used for the assessment of psychosocial factors at work. The results were compared with professional group-specific reference values (geriatric care) from the COPSOQ database.

RESULTS

The comparison of nursing staff with and without a migration background revealed that the emotional demands, work-privacy conflict and role conflicts factors received a significantly better rating among nursing staff with a migration background, while development opportunities were rated worse by this population group. The surveyed nursing staff exhibited higher stress values compared to the COPSOQ reference group in almost all scales.

CONCLUSION

Nursing staff with a migration background need to be supported with respect to development opportunities. Suitable education and training measures may offer adequate career perspectives and may encourage employees to stay in their jobs.

QFT-Plus: a plus in variability? - Evaluation of new generation IGRA in serial testing of students with a migration background in Germany

BACKGROUND

Currently available Interferon-gamma release assays (IGRAs) show a considerable variability in serial testing for latent tuberculosis infection (LTBI). This study offers first results for the new generation IGRA QuantiFERON-TB Gold Plus (QFT-Plus) introduced in 2015 in comparison with its predecessor QuantiFERON-TB Gold In-Tube (QFT-GIT) from serial testing of students with a migration background at German universities.

METHODS

Forty-one students were selected from a previous study. All students with a positive IGRA were asked and 11 agreed to participate in this cohort study. Additionally 30 students with negative IGRA results were selected by chance. Weekly testing with QFT-Plus and QFT-GIT was performed in all individuals over a 4-week period. IGRA variability was evaluated by calculating conversion and reversion rates.

RESULTS

From 41 participants a total number of 163 serial measurements were analyzed for each IGRA, leading to 122 possible IGRA changes each. QFT-Plus had four conversions and two reversions leading to a conversion rate of 4.3% (4 of 93 possible conversions, 95% CI 1.4-11.3%) and reversion rate of 6.9% (2 of 29 possible reversions, 95% CI 1.2-24.2%). QFT-GIT had 2 conversions and 1 reversion causing slightly lower rates with 2.2% conversions (2 of 91, 95% CI 0.4-8.5%) and 3.2% reversions (1 of 31, 95% CI 0.2-18.5%). Inconsistent IGRA results occurred in 4 subjects for QFT-Plus (8 stable positives, 29 stable negatives) and in 2 subjects for QFT-GIT (9 stable positives, 30 stable negatives). Agreement between the two IGRAs was 95.1% (κ = 0.89). Variance attributed to the individuals was low (QFT-Plus: ICC = 0.88).

CONCLUSION

This study confirms occurrence of conversions and reversions for the new QFT-Plus in serial testing of a high-risk cohort in a low-incidence setting with improbable new TB contact during the study. QFT-Plus conversion and reversion rates were slightly higher than for the QFT-GIT but overall they were lower for both IGRAs than in other studies that investigated IGRA variability.

[The prevalence of latent tuberculosis infections among health-care workers--a three-country comparison]

INTRODUCTION

Health-care workers are regularly screened for tuberculosis. To date, there has been no systematic analysis of the results of such a screening. A TB network for company doctors was created when interferon-γ release assays (IGRAs) were introduced in order to systematically collate their experience with IGRAs in preventive check-ups.

METHOD

Data have so far been recorded from 2,028 preventive check-ups. There are also data from preventive check-ups in France (n=148) and Portugal (n=2,889) for the purposes of a combined analysis. QuantiFERON-TB® Gold In-Tube and the tuberculin skin test with RT23 were used in the three cohorts.

RESULTS

The prevalence of latent tuberculosis infections (LTBI) is dependent on age and country. Among young health-care workers (<25 years old), 3% had a positive IGRA in Germany, compared with 18% in Portugal. Among health-care workers aged 55 and over, 25% were positive in Germany and 45% were positive in Portugal. In the French cohort an increase from 23% to 33% was observed when the youngest and oldest age categories were compared. Active tuberculosis has so far been diagnosed in 12 health-care workers in Portugal, four of whom developed culturally confirmed TB within the first two years following a positive IGRA. The risk of progression subsequent to a positive IGRA was 0.2% per annum.

DISCUSSION

There is a low prevalence of LTBI among young health-care workers. In them a positive IGRA following close contact with an infectious patient is likely to indicate recent infection. Apart from that, older infections appear to prevail, as the IGRA results depend greatly on age, and the risk of progression following a positive IGRA appears to be low in the study groups. A positive IGRA should therefore be interpreted with caution as an indication of the need for chemotherapy.

[Violence and aggression in care-related jobs--a literature overview]

For many people working in the care sector, aggression and violence are part of their everyday working life. In order to obtain an overview of the occurrence of violence and aggression in care-related jobs, the current literature on this topic has been analysed. Most published studies are in English and refer to psychiatric facilities. There are fewer analyses of facilities that provide care for the elderly, and facilities that look after people with disabilities have been analysed even less frequently. The German as well as the English literature provides no clues as to the valid prevalence rates in the various fields of the health sector. It is particularly difficult to comment on the prevalence rates because different tools have been used to collect the information. In addition, the definitions of violence and aggression used differ from study to study. In the present article, we introduce fourteen tools that have been developed to record aggressive behaviour towards others. The choice of the tools should be based on the choice of the target group. There are hints indicating that the Staff Observation Aggression Scale-Revised (SOAS-R) is the most suitable tool to record aggressive behaviour prospectively across all fields in the health care sector.

[Prevalence of latent tuberculosis infection in healthcare workers in geriatric care]

INTRODUCTION

The incidence of active tuberculosis rises with age. The present study examined whether this results in an increased prevalence of latent tuberculosis infection (LTBI) in healthcare workers (HCW) in geriatric care, using other HCW as comparison group.

METHODS

Data collection was performed by occupational physicians in three hospitals. The LTBI was diagnosed using the QuantiFERON-TB Gold in Tube (QFT-IT), an Interferon-gamma Release Assay (IGRA). The odds ratios adjusted for age, gender and migration were calculated.

RESULTS

A total of 454 HCW were examined, 58 (12.8 %) of whom worked at geriatric care units. The prevalence of LTBI was 19.0 % in geriatric care and 10.5 % in other HCW. The age, gender, and migration adjusted odds ratio for a positive QFT-IT was 2.4 (5 % CI 1.1 - 5.2) in health care workers working at geriatric care units. A strong positive association between age and LTBI was observed. The prevalence of LTBI increased from 4.6 % in HCW younger than 30 years to 69.2 % in HCW older than 60 years (p < 0.0005).

DISCUSSION

The data suggest an elevated prevalence of LTBI and therefore an elevated infection risk for HCW engaged in geriatric care. The increase of the LTBI prevalence with age might be explained by longer exposure time at work but also by a cohort effect.

Evaluation of the interferon-gamma release assay in healthcare workers

OBJECTIVES

An in vitro test for the diagnosis of latent TB-infection (LTBI) is now available that has the potential to replace the tuberculin skin test (TST). The new test measures the cell-mediated immune response to TB antigens. Little experience is currently available on the performance of the IGRA when testing HCW for LTBI. Therefore the aim of the study was to compare the IGRA with the TST in testing HCW for LTBI.

METHODS

The medical staffs of three hospitals were simultaneously tested with TST (RT23) and IGRA (QFT). The study comprises 261 HCW, all exposed to active TB-patients. Information on gender, age, workplace, BCG vaccination and history of both TB and TST were collected using a standardised questionnaire.

RESULTS

The TST was positive in 24.1% and the IGRA in 9.6% of the participants. Agreement between the tests was low in HCW with a BCG-vaccination. A history of an earlier TST was a risk factor for a positive TST but not for a positive IGRA. Out of 48 results positive in the TST but negative in the IGRA 97.8% might be explained by BCG vaccination or an earlier TST. A positive association between age and LTBI was observed for the IGRA but not for the TST results. Out of 25 positive results in the IGRA only 60% were recognized by the TST, too. The HCW with a positive IGRA and a negative TST had the same age (mean 49.1) as the HCW positive in both tests (mean 50.9), which was higher than the age of those negative in both tests (mean 38.8).

CONCLUSIONS

The data indicate that the IGRA should replace the TST in serial testing of HCW in high income, low incidence countries. The recommendations to use the IGRA in order to verify a positive TST only should be reconsidered.