Tuberculin skin testing and QuantiFERON™-TB Gold Plus positivity among household contacts in Vietnam

SETTING

TB infection (TBI) is diagnosed using the technique-dependent tuberculin skin test (TST) or costly, more accurate interferon-gamma release assays. The TST (⩾10 mm) threshold was indicated by previous research among household contacts in Vietnam, but routine implementation with a different tuberculin reagent showed unexpectedly low TST positivity.

OBJECTIVE

TST (⩾5 mm and ⩾10 mm) results were compared to QuantiFERON™-TB Gold Plus (QFT) results in household contacts during community campaigns in 2020 and 2021.

DESIGN

This was a cross-sectional multi-center implementation study.

RESULTS

Among 1,330 household contacts in 2020, we found a TBI prevalence of 38.6% (QFT), similar to TST ⩾5 mm (37.4%) and higher than TST ⩾10 mm (13.1%). QFT+/TST+ was higher for TST ⩾5 mm (20.7%) than TST ⩾10 mm (9.4%). QFT was not discordant with TST ⩾5 mm (McNemar's test = 0.6, P = 0.5) but was discordant with TST ⩾10 mm (McNemar's test = 263.9, P < 0.01). Older age and Southern region increased odds for positive TST ⩾5 mm and QFT with weaker associations for TST ⩾10 mm. Agreement and discordance were similar in 2021 for 1,158 household contacts.

CONCLUSION

Tuberculin reagents affect TST positivity rates. High TB burden countries should monitor reliability of TBI diagnosis, including tuberculin potency, cold chain, and TST technique to optimize eligibility for TB preventive treatment.

Skin-friction drag analysis from the forced convection modeling in simplified underwater swimming

This study deals with skin-friction drag analysis in underwater swimming. Although lower than profile drag, skin-friction drag remains significant and is the second and only other contribution to total drag in the case of underwater swimming. The question arises whether varying the thermal gradient between the underwater swimmer and the pool water may modify the surface shear stress distribution and the resulting skin-friction drag acting on a swimmer's body. As far as the authors are aware, such a question has not previously been addressed. Therefore, the purpose of this study was to quantify the effect of this thermal gradient by using the integral formalism applied to the forced convection theory. From a simplified model in a range of pool temperatures (20-30 degrees C) it was demonstrated that, whatever the swimming speeds, a 5.3% reduction in the skin-friction drag would occur with increasing average boundary-layer temperature provided that the flow remained laminar. However, as the majority of the flow is actually turbulent, a turbulent flow analysis leads to the major conclusion that friction drag is a function of underwater speed, leading to a possible 1.5% reduction for fast swimming speeds above 1m/s. Furthermore, simple correlations between the surface shear stress and resulting skin-friction drag are derived in terms of the boundary-layer temperature, which may be readily used in underwater swimming situations.