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Yuan Y, Wang X, Zhou Y, Zhou C, Li S. Prevalence and risk factors of latent tuberculosis infection among college students: a systematic review and meta-analysis. Public Health 2022; 213:135-146. [PMID: 36410119 DOI: 10.1016/j.puhe.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/11/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES College students are at increased risk of tuberculosis (TB), which increases their likelihood of developing latent tuberculosis infections (LTBI). This study aimed to estimate the pooled prevalence of LTBI and identify its risk factors. STUDY DESIGN Systematic review and meta-analysis. METHODS We searched PubMed, Embase, Scopus, Web of Science, CNKI, Wanfang and CBM databases (10 March 2022) for studies published in any language. The pooled prevalence of LTBI was estimated using random effects methods. Factors associated with LTBI were evaluated by determining standardised mean difference (SMD) with 95% confidence interval (CI). All analyses were performed using the Stata 15.1. RESULTS A total of 50 studies from 18 countries were included, with 44 tuberculin skin test (n = 623,732) and 19 interferon gamma release assay (n = 38,266) estimates. The prevalence of a positive tuberculin skin test was 20% (95% CI: 17-23%), and the prevalence of a positive interferon gamma release assay was 9% (95% CI: 7%-11%) among college students. Older age (SMD: 1.67, 95% CI: 1.31-2.13), no Bacillus Calmette-Guérin vaccination/scar (SMD: 1.51, 95% CI: 1.06-2.16), contact with TB cases (SMD: 1.34, 95% CI: 1.11-1.62), clinical training (SMD: 1.93, 95% CI: 1.65-2.26) and overweight/obesity (SMD: 1.17, 95% CI: 1.06-1.30) were associated with a higher prevalence of LTBI. Sex was not associated with LTBI prevalence. CONCLUSION College students have an increased risk of LTBI, although it varies by geographical area. This meta-analysis provides evidence of risk factors for LTBI in college students. Infection control measures should be conducted for college students with LTBI.
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Affiliation(s)
- Yemin Yuan
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xiyuan Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Yanxin Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
| | - Shixue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China; NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
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Xu M, Lu W, Li T, Li J, Du W, Wu Q, Liu Q, Yuan B, Lu J, Ding X, Li F, Liu M, Chen B, Pu J, Zhang R, Xi X, Zhou R, Mei Z, Du R, Tao L, Martinez L, Lu S, Wang G, Zhu F. Sensitivity, specificity, and safety of a novel ESAT6-CFP10 skin test for tuberculosis infection in China: two randomized, self-controlled, parallel-group phase 2b trials. Clin Infect Dis 2021; 74:668-677. [PMID: 34021314 PMCID: PMC8886919 DOI: 10.1093/cid/ciab472] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Diagnostics to identify tuberculosis infection are limited. We aimed to assess the diagnostic accuracy and safety of the novel ESAT6-CFP10 (EC) skin test for tuberculosis infection in Chinese adults. METHODS We conducted two randomized, parallel-group clinical trials in healthy participants and tuberculosis patients. All participants were tested with the T-SPOT.TB test, then received EC skin test and tuberculin skin test (TST). The diameter of skin indurations and/or redness at injection sites were measured at different time periods. A Bacillus Calmette Guerin (BCG) model was also established to assess the diagnosis of tuberculosis infection using EC skin test. RESULTS In total, 777 healthy participants and 96 tuberculosis patients were allocated to receive the EC skin test at 1.0μg/0.1ml or 0.5μg/0.1ml. The area under the curve was 0.95 (95% CI, 0.91-0.97) from the EC skin test at a dose of 1.0μg/0.1ml at 24-72 hours. Compared to the T-SPOT.TB test, the EC skin test demonstrated similar sensitivity (87.5, 95% CI 77.8-97.2 versus 86.5, 95% CI 79.5-93.4) and specificity (98.9, 95% CI 96.0-99.9 versus 96.1, 95% CI 93.5-97.8). Among BCG vaccinated participants, the EC skin test had high consistency with the T-SPOT.TB test (96.3, 95% CI, 92.0-100.0). No serious adverse events related to the EC skin test were observed. CONCLUSIONS The EC skin test demonstrated both high specificity and sensitivity at a dose of 1.0μg/0.1ml, comparable to the T-SPOT.TB test. The diagnostic accuracy of the EC skin test was not impacted by BCG vaccination.
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Affiliation(s)
- Miao Xu
- National Institutes for Food and Drug Control, Beijing, PR, China
| | - Wei Lu
- Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR, China
| | - Tao Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, PR, China
| | - Jingxin Li
- Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR, China
| | - Weixin Du
- National Institutes for Food and Drug Control, Beijing, PR, China
| | - Qi Wu
- Tianjin Haihe Hospital, Tianjin University, Tianjin, PR, China
| | - Qiao Liu
- Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR, China
| | - Baodong Yuan
- Wuhan Pulmonary Hospital, Wuhan, Hubei Province, PR, China
| | - Jinbiao Lu
- National Institutes for Food and Drug Control, Beijing, PR, China
| | - Xiaoyan Ding
- Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR, China
| | - Feng Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, PR, China
| | - Min Liu
- Center for Disease Control and Prevention of Jurong city, Zhenjiang, Jiangsu Province, PR, China
| | - Baowen Chen
- National Institutes for Food and Drug Control, Beijing, PR, China
| | - Jiang Pu
- Anhui Zhifei Longcom Biopharmaceutical Co., Ltd, Hefei, Anhui Province, PR, China
| | - Rongping Zhang
- Center for Disease Control and Prevention of Jurong city, Zhenjiang, Jiangsu Province, PR, China
| | - Xiuhong Xi
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, PR, China
| | - Rongguang Zhou
- Center for Disease Control and Prevention of Jurong city, Zhenjiang, Jiangsu Province, PR, China
| | - Zaoxian Mei
- Tianjin Haihe Hospital, Tianjin University, Tianjin, PR, China
| | - Ronghui Du
- Wuhan Pulmonary Hospital, Wuhan, Hubei Province, PR, China
| | - Lifeng Tao
- Anhui Zhifei Longcom Biopharmaceutical Co., Ltd, Hefei, Anhui Province, PR, China
| | - Leonardo Martinez
- Boston University, School of Public Health, Department of Epidemiology, Boston, Massachusetts, United States
| | - Shuihua Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, PR, China
| | - Guozhi Wang
- National Institutes for Food and Drug Control, Beijing, PR, China
| | - Fengcai Zhu
- Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, PR, China
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Aksu K, Naziroğlu T, Özkan P. Factors determining COVID-19 pneumonia severity in a country with routine BCG vaccination. Clin Exp Immunol 2020; 202:220-225. [PMID: 32813879 PMCID: PMC7461370 DOI: 10.1111/cei.13507] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
Background The impact of countries’ bacillus Calmette–Guérin (BCG) vaccination policies on the course of coronavirus disease (COVID‐19) outbreak is a curiosity. In this study, the relationship between BCG vaccination status and severity of COVID‐19 pneumonia and the factors affecting disease severity were investigated. Methods A retrospective cross‐sectional study was conducted between March and June 2020 in patients diagnosed with COVID‐19 pneumonia, confirmed by severe acute respiratory syndrome coronavirus‐2 polymerase chain reaction positivity in a nasopharyngeal sample and pulmonary infiltrates in computed chest tomography, in a state hospital in Istanbul, Turkey. Socio‐demographic features, body mass index, smoking status, concomitant diseases, income rates and BCG vaccination status of subjects were analyzed. Result The study population comprised 123 adults with COVID‐19 pneumonia [mean age = 49·7 years, standard deviation = 13·3 years; 82 (66·7%) male]. While the rate of cases vaccinated with BCG is lower (68·5 versus 88·2%, P = 0·026), mean age (54·0 ± 11·5 years versus 38·3 ± 10·7 years; P < 0·001), diabetes (32·6 versus 5·9%, P = 0·002) and low income (84·3 versus 52·9%, P < 0·001) are higher in patients with severe disease compared to those with mild disease. According to multivariate analysis increasing age [odds ratio (OR) = 1·119; 95% confidence interval (CI) = 1·062–1·178, P < 0·001] and low income (OR = 3·209; 95% CI = 1·008–10·222, P = 0·049) are associated with severe disease in COVID‐19 pneumonia. Conclusion This study reveals that BCG vaccination is not associated with disease severity in COVID‐19 pneumonia. Age and low income are the main determinants of severe COVID‐19 pneumonia.
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Affiliation(s)
- K Aksu
- Division of Immunology and Allergy, Department of Chest Diseases, University of Health Sciences Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey
| | - T Naziroğlu
- Pendik State Hospital, Chest Diseases Clinic, Istanbul, Turkey
| | - P Özkan
- Pendik State Hospital, Chest Diseases Clinic, Istanbul, Turkey
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Use of interferon-gamma release assay and tuberculin skin test in diagnosing tuberculosis in Lithuanian adults: A comparative analysis. MEDICINA-LITHUANIA 2017; 53:159-165. [PMID: 28712669 DOI: 10.1016/j.medici.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 02/08/2017] [Accepted: 05/18/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Lithuania belongs to the group of countries with a high-incidence of tuberculosis (TB). Some scientific studies show that the interferon-gamma release assay is more accurate and correlates more highly with TB exposure as compared to the tuberculin skin test (TST). This study aimed at comparing the efficacy between the T SPOT TB and TST for diagnosing TB among Lithuanian adults. MATERIALS AND METHODS Individuals with diagnosed TB, healthcare workers with known risk for TB and individuals without any known risk for TB underwent clinical examinations, interviews about their history of TB exposure and chest radiography. Then the TST and the T SPOT TB were performed on patients. RESULTS A positive T SPOT TB was more common in the group with diagnosed TB compared to healthcare workers and the low risk for TB groups (97.5%, 36.4%, and 0%, respectively, P<0.01). Positive TST results did not differ between the groups with diagnosed TB and the healthcare workers (92.5% vs. 95.5%, P>0.05). Agreement between TST and T SPOT TB was poor (kappa 0.14, P>0.05). T SPOT TB had higher specificity and sensitivity compared to TST (area under the ROC 0.9±0.04, P<0.01, vs. 0.5±0.06, P>0.05). CONCLUSIONS The T SPOT TB showed greater accuracy in diagnosing TB than TST did. Positive T SPOT TB result but not the TST was more common in patients with diagnosed TB.
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An der Heiden M, Hauer B, Fiebig L, Glaser-Paschke G, Stemmler M, Simon C, Rüsch-Gerdes S, Gilsdorf A, Haas W. Contact investigation after a fatal case of extensively drug-resistant tuberculosis (XDR-TB) in an aircraft, Germany, July 2013. ACTA ACUST UNITED AC 2017; 22:30493. [PMID: 28367796 PMCID: PMC5388132 DOI: 10.2807/1560-7917.es.2017.22.12.30493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/15/2016] [Indexed: 11/20/2022]
Abstract
In July 2013, a passenger died of infectious extensively drug-resistant tuberculosis (XDR-TB) on board of an aircraft after a 3-hour flight from Turkey to Germany. Initial information indicated the patient had moved about the aircraft coughing blood. We thus aimed to contact and inform all persons exposed within the aircraft and to test them for newly acquired TB infection. Two-stage testing within 8 weeks from exposure and at least 8 weeks after exposure was suggested, using either interferon gamma release assays (IGRAs) or tuberculin skin test (TST). The TST cut-off was defined at a diameter > 10 mm; for differentiation between conversion and boosting, conversion was defined as increase of skin induration > 5 mm. Overall, 155 passengers and seven crew members were included in the investigation: the questionnaire response rate was 83%; 112 (69%) persons were tested at least once for TB infection. In one passenger, who sat next to the area where the patient died, a test conversion was registered. As of March 2017, no secondary active TB cases have been reported. We describe an unusual situation in which we applied contact tracing beyond existing European guidelines; we found one latent tuberculosis infection in a passenger, which we consider probably newly acquired.
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Affiliation(s)
| | | | | | - Gisela Glaser-Paschke
- Zentrum für tuberkulosekranke und -gefährdete Menschen, Gesundheitsamt Lichtenberg, Berlin, Germany
| | | | - Claudia Simon
- Landesamt für Gesundheit und Soziales, Berlin, Germany
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Mariette X, Vencovsky J, Lortholary O, Gomez-Reino J, de Longueville M, Ralston P, Weinblatt M, van Vollenhoven R. The incidence of tuberculosis in patients treated with certolizumab pegol across indications: impact of baseline skin test results, more stringent screening criteria and geographic region. RMD Open 2015; 1:e000044. [PMID: 26509064 PMCID: PMC4613160 DOI: 10.1136/rmdopen-2014-000044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/01/2015] [Accepted: 03/27/2015] [Indexed: 02/07/2023] Open
Abstract
Objectives We report the incidence of tuberculosis (TB) across certolizumab pegol (CZP) clinical trials in rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), before and after the introduction of stricter TB screening. Methods TB incidence rates (IRs) were assessed and stratified according to screening guidelines used at the time of CZP trials. Before 2007 (original trials), purified protein derivative (PPD) tuberculin skin test positivity varied according to local standards (induration ≥5 up to ≥20 mm). Since 2007, all CZP trial protocols have been amended, including trials spanning (intermediate) and initiated after 2007 (current), mandating that any patient with PPD≥5 mm receives treatment for latent TB infection (LTBI). All cases of suspected TB or PPD≥5 mm, in pooled data from 5402 CZP patients across all CZP trials up to 2012, underwent blinded central review by independent experts. Results 44 TB cases were confirmed in pooled CZP RA trials (IR 0.47/100PY, patient-years) with no cases in Japanese RA trials (J-RAPID, HIKARI). Single TB cases were confirmed in psoriasis and axSpA trials (RAPID-axSpA), and no cases in the PsA trial (RAPID-PsA). IR of TB was 0.51/100PY across original or intermediate RA trials and 0.18/100PY in current trials. The majority of TB cases in RA occurred in Eastern (IR 1.02/100PY) and Central Europe (IR 0.58/100PY). Of 242/370 PPD≥5 mm patients who received 9 months isoniazid (INH) treatment for latent TB infection (LTBI), none developed TB, versus 7.8% of 128 untreated PPD≥5 mm patients. Conclusions Implementation of more stringent LTBI screening, plus treatment for LTBI, reduced the IR of TB, even when INH was administered after starting CZP therapy.
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Affiliation(s)
- X Mariette
- Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, AP-HP, INSERM U1184 , Le Kremlin Bicêtre , France
| | - J Vencovsky
- Department of Rheumatology , Institute of Rheumatology, Charles University , Prague , Czech Republic
| | - O Lortholary
- IHU Imagine , Université Paris Descartes, Centre d'Infectiologie Necker Pasteur, Hôpital Necker Enfants Malades, AP-HP, Paris , France
| | - J Gomez-Reino
- Universidad de Santiago de Compostela , Santiago , Spain
| | | | | | - M Weinblatt
- Division of Rheumatology, Immunology and Allergy , Brigham and Women's Hospital , Boston , USA
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Murthy M, Selvam S, Jesuraj N, Bennett S, Doherty M, Grewal HMS, Vaz M. Two-step tuberculin skin testing in school-going adolescents with initial 0-4 millimeter responses in a high tuberculosis prevalence setting in South India. PLoS One 2013; 8:e71470. [PMID: 24039716 PMCID: PMC3765300 DOI: 10.1371/journal.pone.0071470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 06/29/2013] [Indexed: 12/03/2022] Open
Abstract
Background The utility of two-step tuberculin skin testing among adolescents in high tuberculosis prevalence settings is not well established. Objectives To determine the proportion and determinants of a 0-4 mm response to an initial standard tuberculin skin test (TST) and evaluating 'boosting' with repeat testing. Methods Adolescents between 11 and 18 years attending schools/colleges underwent a TST; those with a response of between 0–4 mm had a repeat TST 1-4 weeks later. Results Initial TST was done for 6608/6643 participants; 1257 (19%) developed a 0-4 mm response to the initial TST. Younger age and under-nutrition were more likely to be associated with a 0-4 mm response, while the presence of BCG (Bacillus Calmette Guerin) scar and higher socio-economic class were less likely to be associated with a 0-4 mm response. On repeat testing boosting was seen in 13.2% (145/1098; ≥ 6 mm over the initial test) while 4.3% showed boosting using a more conservative cutoff of a repeat TST ≥ 10 mm with an increment of at least 6 mm (47/1098). History of exposure to a tuberculosis (TB) case was associated with enhanced response. Conclusion The proportion of adolescents who demonstrated boosting on two-step TST testing in our study was relatively low. As a result repeat testing did not greatly alter the prevalence of TST positivity. However, the two-step TST helps identify individuals who can potentially boost their immune response to a second test, and thus, prevents them from being misclassified as those with newly acquired infection, or tuberculin converters. While two-step tuberculin skin testing may have a limited role in population- level TST surveys, it may be useful where serial tuberculin testing needs to be performed to distinguish those who show an enhanced response or boosters from those who indeed have a new infection, or converters.
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Affiliation(s)
- Maitreyi Murthy
- Department of Clinical Science, Infection, Faculty of Medicine and Dentistry, University of Bergen
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- St. John’s Research Institute, Bangalore, Karnataka, India
| | - Sumithra Selvam
- Division of Epidemiology, Biostatistics and Population Health, St. John’s Research Institute, Bangalore, Karnataka, India
| | - Nelson Jesuraj
- Division of Epidemiology, Biostatistics and Population Health, St. John’s Research Institute, Bangalore, Karnataka, India
| | - Sean Bennett
- Infectious Disease Epidemiology, St. John’s Research Institute, Bangalore, Karnataka, India
| | - Mark Doherty
- Clinical Development, Aeras Global TB Vaccine Foundation, Rockville, Maryland, United States of America
| | - Harleen M. S. Grewal
- Department of Infectious Disease Immunology, GlaxoSmithKline, Copenhagen, Denmark
- * E-mail: (HMSG); (MV)
| | - Mario Vaz
- Department of Clinical Science, Infection, Faculty of Medicine and Dentistry, University of Bergen and Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- * E-mail: (HMSG); (MV)
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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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Costa NMX, Albuquerque MD, Lins JBA, Alvares-Junior JT, Stefani MMDA. Resposta de testes de hipersensibilidade tardia utilizando PPD e outros antígenos em crianças e adolescentes saudáveis e infectados pelo HIV-1 e vacinados com BCG. Rev Soc Bras Med Trop 2011; 44:542-5. [DOI: 10.1590/s0037-86822011005000054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 02/21/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A contagem de células CD4+ representa marcador da resposta imune celular em pacientes infectados pelo HIV-1. Testes cutâneos de hipersensibilidade tardia (DTH) podem ser empregados para avaliar in vivo respostas celulares a antígenos comuns. MÉTODOS: DTH para derivado proteico purificado de tuberculina (PPD), esporotriquina, tricofitina, candidina e estreptoquinase/estreptodornase foram realizados. Foram testados crianças/adolescentes infectados pelo HIV-1 (n=36) e indivíduos saudáveis (n=56), soronegativos para HIV-1/HIV-2 pareados por sexo-idade, todos com cicatriz vacinal por BCG. Teste exato de Fisher foi aplicado (p<0,05). RESULTADOS: Entre as crianças/adolescentes infectados pelo HIV-1, mediana de idade=8,1 anos; 20/36 eram do sexo masculino; 35 casos de transmissão vertical; 34 casos de AIDS sob terapia antirretroviral; mediana de carga viral = 3.04lc10 cópias/ml; mediana de contagem de células CD4+ = 701 células/μl. Entre os infectados e saudáveis a reatividade DTH a pelo menos um dos antígenos foi, respectivamente, 25% (9/36) e 87,5% (49/56) (p<0,001). Reatividade à candidina predominou nos infectados (8/36, 22%) e ao PPD nos indivíduos saudáveis (40/56, 71,4%). A reatividade ao PPD entre infectados foi de 8,3% (p<0,01). A mediana da induração ao PPD foi 2,5mm (variação: 2-5mm) entre infectados e 6,0mm (variação: 3-15mm) entre os saudáveis. Não observamos correlação entre positividade ao PPD e idade. No grupo de infectados, não observamos correlação entre contagens de células CD4+ e reatividade ao DTH. CONCLUSÕES: Respostas DTH significativamente diminuídas, incluindo a reatividade ao PPD foram observadas em crianças/adolescentes infectados pelo HIV-1 comparadas com controles saudáveis, provavelmente refletindo doença avançada e supressão da imunidade mediada por células T.
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Jeon K, Ji SH, Oh SY, Lee JB, Kim HJ, Choi CM. Boosted reaction on two-step tuberculin skin test among military personnel in South Korea, a setting with an intermediate burden of tuberculosis and routine bacille Calmette-Guerin vaccination. J Korean Med Sci 2008; 23:402-5. [PMID: 18583874 PMCID: PMC2526534 DOI: 10.3346/jkms.2008.23.3.402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study was performed to estimate the rate of boosted reaction in the two-step tuberculin skin test (TST) and to evaluate the associated factors among military personnel of South Korea, which has an intermediate burden of tuberculosis (TB) and a routine bacille Calmette-Guerin (BCG) vaccination policy. Two-step TST was performed on 264 military personnel who did not have a history of close contact to TB. Subjects with a negative reaction to the first test of <10 mm had a second TST applied 1 week later on the other forearm. A positive result (> or =10 mm) on the initial TST was observed in 126 (48%) of the subjects. A boosted reaction on the second TST developed in 32 (23%) of the 124 subjects with a negative initial TST. In multiple logistic regression analysis, the size of the initial TST reaction was the only factor associated with a boosted reaction on the second TST. The high rate of boosted reaction among healthy adults in South Korea suggests that two-step TST should be performed to assess the baseline TST reactivity in settings with an intermediate burden of TB and routine BCG vaccination policy, especially among subjects with an initial TST reaction that is > or =5 mm.
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Affiliation(s)
- Kyeongman Jeon
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Sang-Hoon Ji
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Soo-Yon Oh
- The Korean Institute of Tuberculosis, Seoul, Korea
| | - Jin-Beom Lee
- The Korean Institute of Tuberculosis, Seoul, Korea
| | - Hee-Jin Kim
- The Korean Institute of Tuberculosis, Seoul, Korea
| | - Chang-Min Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Gómez-Reino JJ, Carmona L, Angel Descalzo M. Risk of tuberculosis in patients treated with tumor necrosis factor antagonists due to incomplete prevention of reactivation of latent infection. ACTA ACUST UNITED AC 2007; 57:756-61. [PMID: 17530674 DOI: 10.1002/art.22768] [Citation(s) in RCA: 264] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the causes of new cases of active tuberculosis (ATB) in patients treated with tumor necrosis factor (TNF) antagonists included in the national registry BIOBADASER (Base de Datos de Productos Biológicos de la Sociedad Española de Reumatología) after the dissemination of recommendations to prevent reactivation of latent tuberculosis infection (LTBI). METHODS Incidence rate of ATB per 100,000 patient-years and 95% confidence intervals (95% CIs) were calculated in patients entering BIOBADASER after March 2002 and were stratified by compliance with recommendations (complete or incomplete). ATB rates in BIOBADASER were compared with the background rate and the rate in the rheumatoid arthritis cohort EMECAR (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide) not treated with TNF antagonists. In addition, rates of ATB among patients treated with adalimumab, etanercept, and infliximab were estimated and compared only for treatments started after September 2003, when all 3 drugs became fully available. RESULTS Following March 2002, a total of 5,198 patients treated with a TNF antagonist were registered in BIOBADASER. Fifteen ATB cases were noted (rate 172 per 100,000 patient-years, 95% CI 103-285). Recommendations were fully followed in 2,655 treatments. The probability of developing ATB was 7 times higher when recommendations were not followed (incidence rate ratio 7.09, 95% CI 1.60-64.69). Two-step tuberculosis skin test for LTBI was the major failure in complying with recommendations. CONCLUSION New cases of ATB still occur in patients treated with all available TNF antagonists due to lack of compliance with recommendations to prevent reactivation of LTBI. Continuous evaluation of recommendations is required to improve clinical practice.
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Affiliation(s)
- Juan J Gómez-Reino
- Hospital Clínico Universitario, University of Santiago de Compostela School of Medicine, Santiago, Spain.
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