Management of Latent Tuberculosis Infection Among Healthcare Workers: 10-Year Experience at a Single Center

Perez, Esther Arguello; Seo, Susan K.; Schneider, W.; Eisenstein, Cynthia; Brown, Arthur E.

doi:10.1093/cid/cix725

Cited by 26 publications

(37 citation statements)

References 32 publications

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“…The rate of clinically significant and severe hepatotoxicity (grade 3 and 4) reported in this study (1.1%) is lower than a median rate of 1.8% (range 0.1–11.9%) reported in a study on age-related hepatotoxicity following 6-9 months of isoniazid [ 16 ]. In accordance with other studies, we found a higher rate of grade 3 and 4 hepatotoxicity with increasing age [ 7 , 16 , 36 ], lower rates with 3RPH compared with other regimens [ 20 , 26 , 35 , 38 ], rare need for hospitalization, and no deaths [ 13 , 16 , 27 , 36 , 39 , 40 ].…”

Section: Discussionsupporting

confidence: 92%

“…Completion rates are commonly reported as inversely related to treatment length [ 7 ]. Unsupervised six to nine months of isoniazid treatments in the US have shown around 50% completion rates [ 10 , 11 , 19 , 20 ], 3–4 months RH regimens are reported at 85–90% [ 13 , 21 – 23 ] and recent studies report similarly high completion rates with weekly (supervised) 3RPH administration [ 24 – 28 ]. Our results are consistent with a 2017 review [ 29 ] reporting no important differences in efficacy and completion rates for the 3RPH regimen when compared to other regimens.…”

Section: Discussionmentioning

confidence: 99%

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Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study

et al. 2018

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BackgroundSuccessful treatment of latent tuberculosis infection (LTBI) is essential to reduce tuberculosis (TB) incidence rates in low-burden countries. This study measures treatment completion and determinants of non-completion of LTBI treatment in Norway in 2016.MethodsThis prospective cohort study included all individuals notified with LTBI treatment to the Norwegian Surveillance System for Infectious Diseases (MSIS) in 2016. We obtained data from MSIS and from a standardized form that was sent to health care providers at the time of patient notification to MSIS. We determined completion rates. Pearson’s chi squared test was used to study associations between pairs of categorical variables and separate crude and multivariable logistic regression models were used to identify factors associated with treatment completion and adverse drug effects.ResultsWe obtained information on treatment completion from 719 of the 726 individuals notified for LTBI treatment in 2016. Overall, 91% completed treatment. Treatment completion was highest in the foreign-born group [foreign-born, n = 562 (92%) vs Norwegian-born, n = 115 (85%), p = 0.007]. Treatment completion did not differ significantly between prescribed regimens (p = 0.124). Adverse events were the most common reason for incomplete treatment. We found no significant differences in adverse events when comparing weekly rifapentine (3RPH) with three months daily isoniazid and rifampicin (3RH). However, there were significantly fewer adverse events with 3RPH compared to other regimens (p = 0.037). Age over 35 years was significantly associated with adverse events irrespective of regimen (p = 0.024), whereas immunosuppression was not significantly associated with adverse events after adjusting for other variables (p = 0.306). Treatment under direct observation had a significant effect on treatment completion for foreign-born (multivariate Wald p-value = 0.017), but not for Norwegian-born (multivariate Wald p-value = 0.408) individuals.ConclusionsWe report a very high treatment completion rate, especially among individuals from countries with high TB incidence. The follow-up from tuberculosis-coordinators and the frequent use of directly observed treatment probably contributes to this. Few severe adverse events were reported, even with increased age and in individuals that are more susceptible. While these results are promising, issues of cost-effectiveness and targeting treatment to individuals at highest risk of TB are important components of public health impact.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3468-z) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study

et al. 2018

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“…Despite that, HCWs who lack sufficient medical knowledge refuse medicine intake by claiming that INH harms the liver. The refusal rate in the current study was exceedingly high in comparison to some studies [36], whereas it was low in comparison to others [37]. Notably, acceptance of anti-TB chemoprophylaxis is low among health employees in comparison to the general population [37,38].…”

Section: Discussioncontrasting

confidence: 63%

“…The refusal rate in the current study was exceedingly high in comparison to some studies [36], whereas it was low in comparison to others [37]. Notably, acceptance of anti-TB chemoprophylaxis is low among health employees in comparison to the general population [37,38]. Therefore, ensuring medical efforts to educate the healthcare staff particularly non-professionals, is a priority to encourage chemoprophylaxis acceptance.…”

Section: Discussionmentioning

confidence: 58%

Latent Tuberculosis Infection among Healthcare Workers in Duhok Province: From Screening to Prophylactic Treatment

2019

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Healthcare workers (HCWs) are at increased risk of infection with Mycobacterium tuberculosis (Mtb) and, hence, of developing tuberculosis (TB) disease. The aims of this study are to identify the prevalence and determinants of latent TB infection (LTBI) among HCWs in Duhok Province. This is a cross-sectional prospective study conducted during April–July 2018 in different health care facilities of Duhok province. HCWs at multiple levels were selected by a non-systematic random sampling method. Information on demographic and associated risk factors of LTBI were collected by using a standardized questionnaire. Thereafter, all HCWs underwent QuantiFERON Gold Plus (QFT-Plus) assay. HCWs with indeterminate QFT-Plus underwent a Tuberculin Skin Test. HCWs with positive results were further evaluated by smear microscopy investigation and chest X-ray examination. Three hundred ninety-five HCWs were enrolled; 49 (12%) tested positive for LTBI. The mean age of the HCWs was 33.4 ± 9.25 with a female predominance (51.1%). According to the univariate analysis, LTBI was significantly higher among HCWs with the following: age groups ≥ 30 years, alcohol intake, ≥ 11 years of employment, high risk stratification workplaces, and medical doctors. In the multivariate analysis, the age group of 30–39 years (OR = 0.288, 95% CI: 0.105–0.794, p value = 0.016) was the only risk factor associated with LTBI. Further medical investigations did not reveal active TB cases among HCWs with LTBI. With regards to prophylactic treatment, 31 (63.3%) LTBI HCWs accepted the treatment, whereas 18 (36.7%) declined the chemoprophylaxis. Of these 31 HCWs on chemoprophylaxis, 12 (38.7%) received isoniazid (INH) for six months, 17 (54.8%) received INH in combination with rifampicin (RMP) for three months, and two (6.5%) received alternative therapy because of anti-TB drug intolerance. In conclusions, although Iraq is a relatively high TB burden country, the prevalence of LTBI among Duhok HCWs is relatively low. It is important to screen HCWs in Duhok for LTBI, particularly medical doctors, young adults, alcoholics, and those whom had a long duration of employment in high-risk workplaces. The acceptance rate of HCWs with LTBI to chemoprophylaxis was low. Therefore, ensuring medical efforts to educate the healthcare staff particularly, non-professionals are a priority to encourage chemoprophylaxis acceptance.

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“…Completion rates of TB preventive therapy among children and adults are low worldwide . Across 8 studies, the pooled proportion of children completing TB preventive therapy of those started on it was 18.3% (CI95% 6–31%) , lower than the third of children exposed to TB completing IPT in our study setting.…”

Section: Discussionmentioning

confidence: 64%

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

Otero

Battaglioli

Ríos

et al. 2019

Tropical Med Int Health

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Objective Contacts of pulmonary tuberculosis (TB) cases are at high risk of TB infection and progression to disease. Close and household contacts and those <5 years old have the highest risk. Isoniazid preventive therapy (IPT) can largely prevent TB disease among infected individuals. International and Peruvian recommendations include TB contact investigation and IPT prescription to eligible contacts. We conducted a study in Lima, Peru, to determine the number of close and household contacts who were evaluated, started on IPT, and who completed it, and the factors associated to compliance with national guidelines. Methods We conducted a longitudinal retrospective study including all TB cases diagnosed between January 2015 and July 2016 in 13 health facilities in south Lima. Treatment cards, TB registers and clinical files were reviewed and data on index cases (sex, age, smear status, TB treatment outcome), contact investigation (sex, age, kinship to the index case, evaluations at month 0, 2 and 6) and health facility (number of TB cases notified per year, proportion of TB cases with treatment success) were extracted. We tabulated frequencies of contact evaluation by contact and index case characteristics. To investigate determinants of IPT initiation and completion, we used generalised linear mixed models. Results A total of 2323 contacts were reported by 662 index cases; the median number of contacts per case was four (IQR, 2–5). Evaluation at month 0 was completed by 99.2% (255/257) of contacts <5 and 98.1% (558/569) of contacts aged 5–19 years. Of 191 eligible contacts <5 years old, 70.2% (134) started IPT and 31.4% (42) completed it. Of 395 contacts 5–19 years old, 36.7% (145) started IPT and 32.4% (47) completed it. Factors associated to not starting IPT among contacts <5 years old were being a second‐degree relative to the index case (OR 6.6 95CI% 2.6–16.5), not having received a tuberculin skin test (TST) (OR 3.9 95%CI 1.4–10.8), being contact of a smear‐negative index case (OR 5.5 95%CI 2.0–15.1) and attending a low‐caseload health facility (OR 2.8 95%CI 1.3–6.2). Factors associated to not starting IPT among 5–19 year‐olds were age (OR 13.7 95%CI 5.9–32.0 for 16‐19 vs. 5–7 years old), being a second‐degree relative (OR 3.0 95%CI 1.6–5.6), not having received a TST (OR 5.4, 95%CI 2.5–11.8), being contact of a male index case (OR 2.1 95CI% 1.2–3.5), with smear‐negative TB (OR 1.9 95%CI 1.0–3.6), and attending a high‐caseload health facility (OR 2.1 95%CI 1.2–3.6). Factors associated to not completing IPT, among contacts who started, were not having received a TST (OR 3.4 95%CI 1.5–7.9 for <5 year‐olds, and OR 4.3 95%CI 1.7–10.8 for those 5–19 years old), being contact of an index case with TB treatment outcome other than success (OR 9.3 95%CI 2.6–33.8 for <5 year‐olds and OR 15.3 95%CI 1.9–125.8 for those 5–19 years old), and, only for those 5–19 years old, attending a health facility with high caseload (OR 3.2 95%CI 1.4–7.7) and a health facility with low proportion of TB cases with treatment succ...

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Management of Latent Tuberculosis Infection Among Healthcare Workers: 10-Year Experience at a Single Center

Abstract: Completion of RIF and RPT/INH for LTBI in an HCW population is more likely than INH. Rates of discontinuation due to side effects were lower among those taking RPT/INH. Shorter LTBI treatment regimens should be more widely considered for HCWs in the United States.

Cited by 26 publications

References 32 publications

Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study

Treatment completion for latent tuberculosis infection in Norway: a prospective cohort study

Latent Tuberculosis Infection among Healthcare Workers in Duhok Province: From Screening to Prophylactic Treatment

Contact evaluation and isoniazid preventive therapy among close and household contacts of tuberculosis patients in Lima, Peru: an analysis of routine data

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