Assessing the Performance of Overseas Tuberculosis Screening Programs

Maloney, Susan A.; Fielding, Katherine; Laserson, Kayla F.; Jones, Warren L.; Yen, Nguyen Thi Ngoc; An, Dang Quy; Phuoc, Nguyen Huu; Trinh, Nguyen An; Nhung, Duong Thi Cam; Thi, Vo; Seawright, M. Frank; O’Rourke, Thomas; Lien, Truong Xuan; Lan, Nguyễn Thị Ngọc; Binkin, Nancy; Cetron, Martín S.

doi:10.1001/archinte.166.2.234

Cited by 46 publications

(36 citation statements)

References 25 publications

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“…The prevalence of smear-positive TB disease in our study (3 per 1000) was however similar to the previously available community estimates (2.4 to 8.3 per 1000) [22]. However as compared to previous studies done in immigrants from different LMIC [13], [23], [24], [25], [26], [27], [28], [29], [30], the prevalence of radiological inactive TB in our study population was much higher.…”

Section: Discussionsupporting

confidence: 90%

Prevalence of Abnormal Radiological Findings in Health Care Workers with Latent Tuberculosis Infection and Correlations with T Cell Immune Response

et al. 2007

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BackgroundMore than half of all health care workers (HCWs) in high TB-incidence, low and middle income countries are latently infected with tuberculosis (TB). We determined radiological lesions in a cohort of HCWs with latent TB infection (LTBI) in India, and determined their association with demographic, occupational and T-cell immune response variables.MethodologyWe obtained chest radiographs of HCWs who had undergone tuberculin skin test (TST) and QuantiFERON-TB Gold In Tube (QFT), an interferon-γ release assay, in a previous cross-sectional study, and were diagnosed to have LTBI because they were positive by either TST or QFT, but had no evidence of clinical disease. Two observers independently interpreted these radiographs using a standardized data form and any discordance between them resolved by a third observer. The radiological diagnostic categories (normal, suggestive of inactive TB, and suggestive of active TB) were compared with results of TST, QFT assay, demographic, and occupational covariates.ResultsA total of 330 HCWs with positive TST or QFT underwent standard chest radiography. Of these 330, 113 radiographs (34.2%) were finally classified as normal, 206 (62.4%) had lesions suggestive of inactive TB, and 11 (3.4%) had features suggestive of active TB. The mean TST indurations and interferon-γ levels in the HCWs in these three categories were not significantly different. None of the demographic or occupational covariates was associated with prevalence of inactive TB lesions on chest radiography.Conclusion/SignificanceIn a high TB incidence setting, nearly two-thirds of HCWs with latent TB infection had abnormal radiographic findings, and these findings had no clear correlation with T cell immune responses. Further studies are needed to verify these findings and to identify the causes and prognosis of radiologic abnormalities in health care workers.

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Section: Discussionsupporting

confidence: 90%

Prevalence of Abnormal Radiological Findings in Health Care Workers with Latent Tuberculosis Infection and Correlations with T Cell Immune Response

et al. 2007

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“…In general, only individuals entering the United States as immigrants or refugees are subject to a TB screening before entry. 22 Of the foreign-born HCWs in this analysis, 25% received a diagnosis of TB within 2 years after arrival to the United States, which suggests that infection was acquired before entry rather than within the United States, which is a finding consistent with other studies. 23,24 According to the reported data, HCWs were less likely than other adults with TB to have received all doses of treatment by DOT.…”

Section: Discussionsupporting

confidence: 88%

Tuberculosis among Healthcare Workers, United States, 1995–2007

Lambert

Pratt

Armstrong

et al. 2012

Infect. Control Hosp. Epidemiol.

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OBJECTIVE-We examined surveillance data to describe the epidemiology of tuberculosis (TB) among healthcare workers (HCWs) in the United States during the period 1995-2007.DESIGN-Cross-sectional descriptive analysis of existing surveillance data. CONCLUSIONS-Healthcare institutions may benefit from intensifying TB screening of HCWs upon hire, especially persons from countries with a high incidence of TB, and encouraging treatment for latent TB infection among HCWs to prevent progression to TB disease. SETTING AND PARTICIPANTS-TBSince the early 1990s, outbreaks of tuberculosis (TB) and multidrug-resistant TB in various medical settings have demonstrated patient-to-healthcare worker (HCW) transmission of Mycobacterium tuberculosis, 1-4 and other investigations have suggested that HCWs with untreated latent TB infection (LTBI) can later experience progression to TB disease, which can cause workplace exposure to patients and other HCWs. 5,6 The extent of occupational risk of TB for HCWs varies according to many factors, including prevalence of TB in the patient population, immunocompetency of the HCW, and effectiveness of infection control measures in the healthcare setting. 7 The objective of this analysis was to examine surveillance data and describe the epidemiology of TB among HCWs in the United States during the period 1995-2007.Address correspondence to Lauren Lambert, MPH, Centers for Disease Control and Prevention, 1600 Clifton Road, E-10, Atlanta, GA 30333 (lal0@cdc.gov). Potential conflicts of interest. All authors report no conflicts of interest relevant to this article. All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and the conflicts that the editors consider relevant to this article are disclosed here.The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the Centers for Disease Control and Prevention. HHS Public Access METHODSThis study describes new analyses of existing data routinely submitted to the Centers for Disease Control and Prevention through the National Tuberculosis Surveillance System. These data are collected for the purposes of disease surveillance and not human subject research that requires ethical institutional board review. TB cases were reported by the 50 states and the District of Columbia. Data were collected on a standardized form that included demographic, laboratory, clinical, and treatment outcome information.We Persons were considered to be foreign born if the reported country of birth was outside the United States or its jurisdictions in the Pacific and Caribbean. Method of TB treatment was recorded as (i) directly observed therapy (DOT), (ii) self-administered therapy, (iii) a combination of self-administered therapy and DOT, or (iv) unknown. DOT, an adherenceenhancing strategy in which a HCW or other trained person watches a patient swallow each dose of medication, is the standard care for all patients with TB disease and is a preferred option for patients treated for LTBI i...

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“…However, .80% of new immigrants to the USA who were subsequently diagnosed with active TB, of whom 50% received their positive diagnosis within 30 days after arrival, were screened within the 6 months prior to their arrival in the USA and had had a negative result [88,91]. Accordingly, the ability of current ''overseas'' screening programmes to detect TB based on chest radiography and AFB is considered to be low, leaving persons with AFB-negative active TB, who constitute the majority (65.1%) of new immigrants to the USA, undetected [92].…”

Section: Ltbi In Immigrants From High Incidence Regionsmentioning

confidence: 99%

Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination

Diel

Loddenkemper

Zellweger³

et al. 2013

Eur Respir J

156

133

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The introduction of new rapid diagnostic tools for tuberculosis (TB) and the promising TB drugs pipeline together with the development of a new World Health Organization Strategy post 2015 allows new discussions on how to direct TB control. The European Respiratory Society's European Forum for TB Innovation was created to stimulate discussion on how to best take advantage of old and new opportunities, and advances, to improve TB control and eventually progress towards the elimination of TB.While TB control is aimed at reducing the incidence of TB by early diagnosis and treatment of infectious cases of TB, TB elimination requires focus on sterilising the pool of latently infected individuals, from which future TB cases would be generated.This manuscript describes the three core components that are necessary to implement the elimination strategy fully. 1) Improve diagnosis of latent TB infected individuals. 2) Improve regimens to treat latent TB infection. 3) ensure public health commitment to make both 1) and 2) possible. Old and new evidence is critically described, focusing on the European commitment to reach elimination and on the innovative experiences and best practices available. @ERSpublications Diagnosis and treatment of latent TB infection is the core intervention to reach elimination

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Assessing the Performance of Overseas Tuberculosis Screening Programs

Cited by 46 publications

References 25 publications

Prevalence of Abnormal Radiological Findings in Health Care Workers with Latent Tuberculosis Infection and Correlations with T Cell Immune Response

Prevalence of Abnormal Radiological Findings in Health Care Workers with Latent Tuberculosis Infection and Correlations with T Cell Immune Response

Tuberculosis among Healthcare Workers, United States, 1995–2007

Old ideas to innovate tuberculosis control: preventive treatment to achieve elimination

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