Screening of healthcare workers for latent tuberculosis infection in the low tuberculosis burden country: QuantiFERON-TB gold in tube test or tuberculin skin test?

Abstract

Healthcare workers (HCWs) are an important group at increased risk for exposure to various infectious agents including Mycobacterium tuberculosis. Unfortunately, there is very limited data on the prevalence of latent tuberculosis infection (LTBI) among HCWs in Iran. The aim of this study was to analyze the prevalence of LTBI among HCW’s of Children Medical Center (CMC), an Iranian referral hospital, and to compare the feasibility of using tuberculin skin test (TST) and QuantiFERON-TB gold in tube test (QFT-GIT) to screen the LTBI among this population. Informed consent was obtained before the study questionnaire was completed. Participants were then evaluated for LTBI using QFT-GIT test followed immediately by TST. The prevalence of latent TB infection in the 101 HCWs, based on QFT-GIT positivity, was 47% (n = 47), while based on TST test a higher prevalence was observed (n = 57, 57%). Forty-five (45%) subjects were positive for both tests, whereas 14 (14%) were positive by either test. Among the TST positive cases, 21% (n = 12) were negative for QFT-GIT. The overall agreement of TST and QFT-GIT was 86% ([45 + 42]/101] and a moderate correlation between these two tests was observed (Kappa value 0.72). The use of QFT-GIT test as a second step in TST-positive cases offers an appropriate tool for LTBI detection in our country where all HCWs are BCG-vaccinated. To enable the effective control and prevention of TB in healthcare settings in Iran, specific and detailed guidelines for dealing with LTBI are highly required. All newly hired HCWs should receive baseline testing for LTBI before commencing employment. In addition, HCWs who work in high-risk departments should receive regular follow-up screening for LTBI.