Abstract
Health Care Workers (HCW) may have an occupational risk of latent tuberculosis infection (LTBI) and TB disease. The objective of this study was to evaluate the performance of the 2-step strategy: tuberculin skin test (TST) followed by confirmation with Interferon (IFN)-γ- release assays (IGRAs) in HCW. A secondary objective was to determine the factors related to conversions and reversions. HCW at risk of occupational exposure who attended the Occupational Department of the Hospital Germans Trias i Pujol were included during the study period (2013–2016). All professionals testing negative for LTBI were included in a cohort study. These workers were followed up with the administration of a TST and an IGRA quantification at least one year after inclusion in the study. Workers with positive TST, regardless of the results of the IGRA tests, were followed-up with an IGRA. 255 workers were enrolled in the study and 108 workers from the same cohort were followed up. During the follow-up period, seven workers presented TST test conversion. One of these conversions was also confirmed by an IGRA test. There were 2 conversions of cases only testing positive with the IGRA. There have been only 2 reversions of cases testing negative with the IGRA. In this study, not all TST conversions were confirmed when using the IGRA test, which highlights the importance of the 2-step strategy. We have detected a low number of conversions and reversions. Our conclusions should be confirmed in studies with a longer follow-up time.
Highlights
Tuberculosis (TB) continues to be a major worldwide public health problem [1]
In a systematic review [10] of the use of IGRAs in Health Care Workers (HCW), the authors concluded that the use of IGRAs for serial testing is complicated by lack of data on optimum cut-offs and the unclear interpretation and prognosis of conversions and reversions
In our study only 1 of the 7 conversions with TST were confirmed with the IGRA test, and 4 discordances in the follow-up were in high-degree risk HCW
Summary
Tuberculosis (TB) continues to be a major worldwide public health problem [1]. Health Care Workers (HCW) can have an occupational risk of latent tuberculosis infection (LTBI) and TB. In a systematic review [10] of the use of IGRAs in HCW, the authors concluded that the use of IGRAs for serial testing is complicated by lack of data on optimum cut-offs and the unclear interpretation and prognosis of conversions and reversions. Conclusions from subsequent cohort studies in low incidence settings [11, 12] did not help to clarify the role of conversions and reversions of IGRAs. it seems prudent to screen for tuberculosis infection in HCW with the TST while the result is negative. At the same time this evidence would enable clinicians to better indicate treatment for those individuals for whom the benefit may be greater [4] The objective of this prospective cohort study was to evaluate the performance of the 2-step strategy in HCW at a tertiary hospital. A secondary objective was to determine the factors related to conversions and reversions
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
