Contage tuberculeux néonatal en maternité : dépistage et évolution d’une cohorte de nourrissons exposés

Perry, A.; Angoulvant, François; Chadelat, Katarina; Lauzanne, Agathe de; Houdouin, Véronique; Kheniche, Ahmed; Lorrot, Mathie; Mesples, Bettina; Aujard, Y.; Gaudelus, J.; Grimprel, E.; Faye, Albert

doi:10.1016/j.arcped.2012.01.017

Cited by 5 publications

(8 citation statements)

References 15 publications

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“…Nineteen incidents (16.2%) occurred in nurseries/maternity wards [ 13 – 15 , 17 , 22 – 25 , 27 – 30 , 43 , 44 , 46 , 41 ], 11 in emergency/intensive care/reanimation units [ 32 , 37 , 42 , 44 , 46 ] (9.4%) and 10 in paediatric units [ 16 , 19 , 20 , 21 , 26 , 42 – 44 ] (8.5%). Nine incidents (7.7%) occurred in outpatient settings and five involved more than one setting [ 19 , 34 , 38 , 43 , 44 ].…”

Section: Resultsmentioning

confidence: 99%

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Tuberculosis Transmission from Healthcare Workers to Patients and Co-workers: A Systematic Literature Review and Meta-Analysis

et al. 2015

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Healthcare workers (HCWs) are at risk of becoming infected with tuberculosis (TB), and potentially of being infectious themselves when they are ill. To assess the magnitude of healthcare-associated TB (HCA-TB) transmission from HCWs to patients and colleagues, we searched three electronic databases up to February 2014 to select primary studies on HCA-TB incidents in which a HCW was the index case and possibly exposed patients and co-workers were screened.We identified 34 studies out of 2,714 citations. In 29 individual investigations, active TB was diagnosed in 3/6,080 (0.05%) infants, 18/3,167 (0.57%) children, 1/3,600 (0.03%) adult patients and 0/2,407 HCWs. The quantitative analysis of 28 individual reports showed that combined proportions of active TB among exposed individuals were: 0.11% (95% CI 0.04–0.21) for infants, 0.38% (95% CI 0.01–1.60) for children, 0.09% (95% CI 0.02–0.22) for adults and 0.00% (95% CI 0.00–0.38) for HCWs. Combined proportions of individuals who acquired TB infection were: 0.57% (95% CI 7.28E-03 – 2.02) for infants, 0.9% (95% CI 0.40–1.60) for children, 4.32% (95% CI 1.43–8.67) for adults and 2.62% (95% CI 1.05–4.88) for HCWs. The risk of TB transmission from HCWs appears to be lower than that recorded in other settings or in the healthcare setting when the index case is not a HCW. To provide a firm evidence base for the screening strategies, more and better information is needed on the infectivity of the source cases, the actual exposure level of screened contacts, and the environmental characteristics of the healthcare setting.

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Section: Resultsmentioning

confidence: 99%

“…In 37 out of the 117 incidents, exposed patients were at a high risk of developing active TB once infected with M . tuberculosis because of young age [ 13 – 30 , 41 – 44 ], oncological-hematological diseases [ 38 ], renal diseases [ 31 , 35 ], haemodialysis [ 33 ], HIV infection [ 34 ] or other co-morbidities [ 16 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

Tuberculosis Transmission from Healthcare Workers to Patients and Co-workers: A Systematic Literature Review and Meta-Analysis

et al. 2015

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“…Generally, transmission to newborns after exposure in medical facilities, seems to be rare: to date only three cases of infection [ 11 , 18 ] and few cases of positive TST without signs of active disease have been reported [ 15 , 17 , 20 , 21 ]. Crockett et al found contaminated respiratory equipment to be the most likely source for the nosocomial transmission, whereas Steiner et al found a nurse being the index patient having transmitted the disease to two infants [ 11 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, the modern NICU environment with an active ventilation (6-7times/h) reduces the risk of airborne infections. Yet, Ahn et al and Perry et al report a low percentage of TST conversion in exposed infants in modern NICUs, showing persistent risk of transmission even in highly modern environments [ 15 , 17 ]. This therefore justifies our decision regarding the contact definition of the infants.…”

Section: Discussionmentioning

confidence: 99%

“…In the past years, several NICUs have experienced and reported exposure to sputum smear positive tuberculosis [2,[11][12][13][14][15][16][17][18][19][20][21][22][23]. In most reports, the index patient is a neonate suffering from congenital TB [2,[11][12][13][20][21][22][23] although exposures through HCW are also described [12-14, 22, 23].…”

Section: Index Patient and Contact Definitionsmentioning

confidence: 99%

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Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit

Pop

Kaelin

Kuster

et al. 2022

Antimicrob Resist Infect Control

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Background Several neonatal intensive care units (NICU) have reported exposure to sputum smear positive tuberculosis (TB). NICE guidelines give support regarding investigation and treatment intervention, but not for contact definitions. Data regarding the reliability of any interferon gamma release assay (IGRA) in infants as a screening test for TB infection is scarce. We report an investigation and management strategy and evaluated the viability of IGRA (T-Spot) in infants and its concordance to the tuberculin skin test (TST). Methods We performed an outbreak investigation of incident TB infection in a NICU after prolonged exposure to sputum smear positive miliary TB by an infant’s mother. We defined individual contact definitions and interventions and assessed secondary attack rates. In addition, we evaluated the technical performance of T-Spot in infants and compared the results with the TST at baseline investigation. Results Overall, 72 of 90 (80%) exposed infants were investigated at baseline, in 51 (56.7%) of 54 (60%) infants, follow-up TST at the age of 6 months was performed. No infant in our cohort showed a positive TST or T-Spot at baseline. All blood samples from infants except one responded to phytohemagglutinin (PHA), which was used as a positive control of the T-Spot, demonstrating that cells are viable and react upon stimulation. 149 of 160 (93.1%) exposed health care workers (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection. 5 of 92 (5.5%) exposed primary contacts were tested positive, all coming from countries with high TB incidences. In total, 1 of 342 exposed contacts was newly diagnosed with latent TB infection. The secondary attack rate in this study including pediatric and adult contacts was 0.29%. Conclusion This investigation highlighted the low transmission rate of sputum smear positive miliary TB in a particularly highly susceptible population as infants. Our expert definitions and interventions proved to be helpful in terms of the feasibility of a thorough outbreak investigation. Furthermore, we demonstrated concordance of T-Spot and TST. Based on our findings, we assume that T-Spot could be considered a reliable investigation tool to rule out TB infection in infants.

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Nosocomial exposure to active pulmonary tuberculosis in a neonatal intensive care unit

Ahn

Kim

2015

American Journal of Infection Control

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Contage tuberculeux néonatal en maternité : dépistage et évolution d’une cohorte de nourrissons exposés

Cited by 5 publications

References 15 publications

Tuberculosis Transmission from Healthcare Workers to Patients and Co-workers: A Systematic Literature Review and Meta-Analysis

Tuberculosis Transmission from Healthcare Workers to Patients and Co-workers: A Systematic Literature Review and Meta-Analysis

Low secondary attack rate after prolonged exposure to sputum smear positive miliary tuberculosis in a neonatal unit

Nosocomial exposure to active pulmonary tuberculosis in a neonatal intensive care unit

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