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Farah WH, Breeher LE, Newcomb RD, Murad MH, Vaughn AIS, Hagen PT, Molella RG. Late boosting phenomenon in TST conversion among health care workers. Occup Med (Lond) 2017; 67:484-489. [PMID: 28898965 DOI: 10.1093/occmed/kqx102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Available information is insufficient to guide determination of whether tuberculin skin test (TST) conversions of health care workers (HCWs) within 2 years of two-step testing are related to occupational exposures or to other causes, including late boosting. AIMS To describe the epidemiologic factors of TST conversion in HCWs, comparing early TST conversion (≤2 years after two-step testing) with late conversion to possibly distinguish late boosting phenomenon from occupational TST conversion. METHODS Retrospective analysis of a database of TSTs of HCWs from 1 January 1998, through 31 May 2014, in the United States Midwest. RESULTS In total, 40142 HCWs had 197932 tests over the 16 years, with 123 conversions (conversion rate: 0.3%; 95% CI 0.3-0.4%). Among 61 HCWs with a negative two-step TST, 30 (49%) were found to have early TST conversion within 2 years; 31 (51%) had late conversion, with likely occupational exposure but no identifiable community risks. Persons with early conversion were more likely to be born outside the USA (89% versus 57%; P < 0.05), had a higher rate of prior bacille Calmette-Guérin (BCG) vaccination (89% versus 52%; P < 0.05) and had no identifiable risk factors for conversion (63% versus 58%; P < 0.05). CONCLUSIONS Early conversions among HCWs after negative two-step TST are associated with various nonoccupational factors, including international birth and BCG vaccination history. Therefore, conversion is not a reliable indicator of recent tuberculosis contact in this population, and two-step TST is insufficient to discount a delayed boosting response for HCWs.
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Affiliation(s)
- W H Farah
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - L E Breeher
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - R D Newcomb
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - M H Murad
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - A I S Vaughn
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - P T Hagen
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - R G Molella
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Durando P, Garbarino S, Orsi A, Alicino C, Dini G, Toletone A, Ciprani F, Conte G, Santorsa R, Icardi G. Prevalence and predictors of latent tuberculosis infection among Italian State Policemen engaged in assistance to migrants: a national cross-sectional study. BMJ Open 2016; 6:e012011. [PMID: 27697871 PMCID: PMC5073613 DOI: 10.1136/bmjopen-2016-012011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Better knowledge about tuberculosis (TB) and latent TB infection (LTBI) epidemiology is a crucial step for the development of effective strategies towards the control and elimination of this deadliest and persistent health threat. No study has investigated LTBI epidemiology in policemen who act as an interface with cross-border migrants. METHODS A survey to measure the LTBI prevalence and assess the demographic, professional and clinical features potentially associated with tuberculin skin test (TST) positivity was performed in Italian State Police (ISP) employees engaged, even occasionally, in relief activities, hospitality, photographical identification, escorting and accompanying of migrants, regardless of contact with active TB cases. Variables potentially associated with TST positivity were evaluated with univariate and multivariate analysis. RESULTS From September to December 2014, 4225 ISP workers underwent TST screening and completed the questionnaire for data collection, according to study procedures. The TST was positive in 9.9% of individuals: no active TB cases were registered among the entire study population. Age, previous BCG vaccination and work category resulted independently associated with TST positivity. CONCLUSIONS This is the first study providing updated data about LTBI epidemiology among ISP employees engaged in assistance to migrants and furnish preliminary evidence of possible associations between TST positivity and different conditions that need to be deeply investigated with prospective studies.
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Affiliation(s)
- Paolo Durando
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| | - Sergio Garbarino
- Department of Health Sciences, University of Genoa, Genoa, Italy
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Andrea Orsi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
| | | | - Guglielmo Dini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Fabrizio Ciprani
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Giuseppe Conte
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Roberto Santorsa
- State Police Health Service Department, Ministry of Interior, Rome, Italy
| | - Giancarlo Icardi
- Department of Health Sciences, University of Genoa, Genoa, Italy
- IRCCS AOU San Martino—IST, Genoa, Italy
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Duman N, Ersoy-Evans S, Karadağ Ö, Aşçıoğlu S, Şener B, Kiraz S, Şahin S. Screening for latent tuberculosis infection in psoriasis and psoriatic arthritis patients in a tuberculosis-endemic country: a comparison of the QuantiFERON®-TB Gold In-Tube test and tuberculin skin test. Int J Dermatol 2014; 53:1286-92. [DOI: 10.1111/ijd.12522] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Nilay Duman
- Department of Dermatology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Sibel Ersoy-Evans
- Department of Dermatology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Ömer Karadağ
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Sibel Aşçıoğlu
- Section of Infectious Diseases; Department of Internal Medicine; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Burçin Şener
- Department of Microbiology and Clinical Microbiology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Sedat Kiraz
- Division of Rheumatology; Department of Internal Medicine; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Sedef Şahin
- Department of Dermatology; Faculty of Medicine; Acibadem University; Istanbul Turkey
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Kim CH, Kim JY, Hwang YI, Lee CY, Choi JH, Park YB, Jang SH, Woo H, Kim DG, Lee MG, Hyun IG, Jung KS, Kim HS. Interferon-γ Enzyme-Linked Immunospot Assay in Patients with Tuberculosis and Healthy Adults. Tuberc Respir Dis (Seoul) 2014; 76:23-9. [PMID: 24523814 PMCID: PMC3919961 DOI: 10.4046/trd.2014.76.1.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 10/22/2013] [Accepted: 10/29/2013] [Indexed: 11/25/2022] Open
Abstract
Background Interferon-γ assays based on tuberculosis (TB)-specific antigens have been utilized for diagnosing and ruling out latent TB and active TB, but their utility is still limited for TB incidence countries. The aim of this study is to understand the clinical utility of enzyme-linked immunospot (ELISpot) assays among patients with clinically suspected TB and healthy adults in clinical practices and community-based settings. Methods The ELISpot assays (T SPOT.TB, Oxford Immunotec, UK) were prospectively performed in 202 patients. After excluding those with indeterminate results, 196 were included for analysis: 41 were TB patients, 93 were non-TB patients, and 62 were healthy adults. Results The sensitivity and negative predictive values of the T SPOT.TB assays for the diagnosis of TB were 87.8% and 89.1%, respectively, among patients with suspected TB. The agreement between the tuberculin skin test (10-mm cutoff) and the T SPOT.TB assay was 66.1% (kappa=0.335) in all participants and 80.0% (kappa=0.412) in TB patients. Among those without TB (n=155), a past history of TB and fibrotic TB scar on chest X-rays were significant factors that yielded positive T SPOT.TB results. There was a significant difference in the magnitude of T SPOT.TB spot counts between TB patients and non-TB patients or healthy adults. Conclusion The T SPOT.TB assay appeared to be a useful test for the diagnostic exclusion of TB. A positive result, however, should be cautiously interpreted for potential positives among those without active TB in intermediate TB incidence areas.
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Affiliation(s)
- Cheol-Hong Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jong-Yeop Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong Il Hwang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Chang Youl Lee
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jeong-Hee Choi
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Yong-Bum Park
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Seung-Hun Jang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Heungjeong Woo
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong-Gyu Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Myung Goo Lee
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - In-Gyu Hyun
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Ki-Suck Jung
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Hyun Soo Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Chuncheon, Korea
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Lee SW, Oh SY, Lee JB, Choi CM, Kim HJ. Tuberculin skin test distribution following a change in BCG vaccination policy. PLoS One 2014; 9:e86419. [PMID: 24466082 PMCID: PMC3900524 DOI: 10.1371/journal.pone.0086419] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022] Open
Abstract
Background Epidemiologic data regarding tuberculin skin test (TST) responses are an important basis for TB control strategies. This study analyzed TST responses in Korea, which experienced a rapid change in BCG vaccination status. Methods TST responses in young adults were examined over 5 years. Participants with active TB lesions were excluded. Results A total of 5,552 participants were enrolled with median age of 21 years. When an induration diameter ≥10 mm was used as the criterion for a positive test, TST positivity fell (from 28.0% in 2005 to 15.3% in 2009); however, they remained steady when the criterion was ≥15–20 mm. A positive TST was associated with a personal or family of TB, the presence of a Bacille Calmette-Guérin (BCG) scar, and age (odds ratio [95% confidence interval] = 4.03 [2.61–6.22], 2.91 [1.80–4.71], 1.50 [1.31–1.72], and 1.15 [1.09–1.20], respectively). Among these factors, the decrease of participants with BCG scars was the most prominent change, which appeared to be associated with the change of TST positivity rate. Conclusion Overall, the rate of TST positivity in Korea decreased. However, this trend seems associated with the change of BCG vaccination strategy rather than successful control of LTBI. This study showed that change in BCG vaccination strategy can have great impact on TB epidemiologic survey based on TST.
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Affiliation(s)
- Sei Won Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo Yeon Oh
- The Korean Institute of Tuberculosis, Osong, Republic of Korea
| | - Jin Beom Lee
- The Korean Institute of Tuberculosis, Osong, Republic of Korea
| | - Chang Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Kim
- The Korean Institute of Tuberculosis, Osong, Republic of Korea
- * E-mail:
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Kraut A, Coodin M, Plessis R, McLean D. Predictors of Positive Tuberculin Skin Test (TST) Results after 2‐Step TST among Health Care Workers in Manitoba, Canada. Clin Infect Dis 2004; 39:e113-8. [PMID: 15578349 DOI: 10.1086/425916] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Accepted: 07/29/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Baseline 2-step tuberculin skin testing (TST) is recommended for health care workers (HCWs) to identify cases of the "boosting phenomenon" (i.e., a negative initial TST result followed by a positive result) and to track the risk of acquiring occupational tuberculosis. However, the 2-step TST has been shown to be insufficient to identify all cases of the booster phenomenon in older adults and refugees. The objective of this study was to identify whether a history of bacille Calmette-Guérin (BCG) vaccination and foreign birth--variables that are known to be associated with the booster phenomenon--remain predictors of a positive TST result in a group of HCWs documented to have negative 2-step TST results (i.e., 2 TSTs done 7-28 days apart with indurations <10 mm in diameter). METHODS We performed a retrospective analysis of an employee database in a tertiary care hospital in Winnipeg, Canada. The study population was comprised of 698 HCWs with negative 2-step TST results who underwent a TST 0-2 years after completion of the 2-step procedure. RESULTS Forty-six HCWs (6.6%) had a positive TST result 0-2 years after the 2-step test. In a multiple logistic regression analysis controlling for age, BCG vaccination, foreign birth, sex, and work setting, only history of BCG vaccination (odds ratio [OR], 8.38; 95% confidence interval [CI], 4.04-17.4), foreign birth (OR, 3.19; 95% CI, 1.53-6.62), and high-risk work setting (OR, 2.93; 95% CI, 1.44-5.95) were associated with a positive TST result. CONCLUSIONS Even for HCWs with negative results of 2-step TST, foreign birth and history of BCG vaccination are associated with a positive result of a future TST. Some positive TST results in such HCWs are related to nonoccupational factors, including delayed boosting, rather than to conversion due to recent tuberculosis contact.
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Affiliation(s)
- Allen Kraut
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
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Smith B, Ryan MAK, Gray GC, Polonsky JM, Trump DH. Tuberculosis infection among young adults enlisting in the United States Navy. Int J Epidemiol 2002; 31:934-9. [PMID: 12435763 DOI: 10.1093/ije/31.5.934] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a re-emerging infectious disease threat worldwide. To protect the health and readiness of US military personnel, policies exist to screen for and treat latent TB infection at the time of service entrance. RESULTS of this screening programme have not been recently described. METHODS Multivariate regression techniques were used to evaluate demographic and medical data associated with TB infection among all young adults entering US Navy enlisted service between 1 October 1997 and 30 September 1998. Results A total of 44,128 adults (ages 17-35, 81% male) were screened for TB during this 12-month period. The prevalence of latent TB infection was 3.5%. Place of birth was very strongly associated with TB infection, with foreign-born recruits eight times more likely to have a reactive tuberculin skin test or history of infection. Those who reported their race as 'Asian/Pacific Island' had 3.8 times the odds of having evidence of TB infection compared with 'Caucasian' recruits, even after adjusting for place of birth. CONCLUSIONS The prevalence of TB infection among Navy recruits was last reported as 2.5% nearly 10 years ago. The apparent increase to 3.5% in this large cohort is likely due to a concurrent increase in the number of foreign-born recruits, and it serves to underscore the importance of comprehensive screening and treatment of latent TB infections in this population.
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Affiliation(s)
- Besa Smith
- Department of Defense Center for Deployment Health Research at the Naval Health Research Center, San Diego, CA 92186-5122, USA.
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Targeted tuberculin testing and treatment of latent tuberculosis infection. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med 2000; 161:S221-47. [PMID: 10764341 DOI: 10.1164/ajrccm.161.supplement_3.ats600] [Citation(s) in RCA: 880] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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