Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose

Diel, Roland; Forssbohm, M; Loytved, G.; Haas, Walter; Hauer, Barbara; Maffei, Daniele Fernanda; Magdorf, K.; Nienhaus, Albert; Hl, Rieder; Schaberg, T.; Jp, Zellweger; Loddenkemper, R.

doi:10.1055/s-2007-980089

Cited by 23 publications

(23 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This trend is reflected in most national recommendations concerning TB screening (e.g. NICE [11], Germany [12], Switzerland [13]). These recommendations favour a dual-step testing strategy (TST first, IGRAs second in TST-positive subjects) because in the cost-effectiveness studies available at the time, the possibility of there being substantially different rates of sensitivity and specificity between the methods being compared was not taken into consideration.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of cost and cost-effectiveness of different TB-screening strategies

Nienhaus

Schablon

Costa

et al. 2011

BMC Health Serv Res

107

View full text Add to dashboard Cite

BackgroundInterferon-γ release assays (IGRAs) for TB have the potential to replace the tuberculin skin test (TST) in screening for latent tuberculosis infection (LTBI). The higher per-test cost of IGRAs may be compensated for by lower post-screening costs (medical attention, chest x-rays and chemoprevention), given the higher specificity of the new tests as compared to that of the conventional TST. We conducted a systematic review of all publications that have addressed the cost or cost-effectiveness of IGRAs. The objective of this report was to undertake a structured review and critical appraisal of the methods used for the model-based cost-effectiveness analysis of TB screening programmes.MethodsUsing Medline and Embase, 75 publications that contained the terms "IGRA", "tuberculosis" and "cost" were identified. Of these, 13 were original studies on the costs or cost-effectiveness of IGRAs.ResultsThe 13 relevant studies come from five low-to-medium TB-incidence countries. Five studies took only the costs of screening into consideration, while eight studies analysed the cost-effectiveness of different screening strategies. Screening was performed in high-risk groups: close contacts, immigrants from high-incidence countries and healthcare workers. Two studies used the T-SPOT.TB as an IGRA and the other studies used the QuantiFERON-TB Gold and/or Gold In-Tube test. All 13 studies observed a decrease in costs when the IGRAs were used. Six studies compared the use of an IGRA as a test to confirm a positive TST (TST/IGRA strategy) to the use of an IGRA-only strategy. In four of these studies, the two-step strategy and in two the IGRA-only strategy was more cost-effective. Assumptions about TST specificity and progression risk after a positive test had the greatest influence on determining which IGRA strategy was more cost-effective.ConclusionThe available studies on cost-effectiveness provide strong evidence in support of the use of IGRAs in screening risk groups such as HCWs, immigrants from high-incidence countries and close contacts. So far, only two studies provide evidence that the IGRA-only screening strategy is more cost-effective.

show abstract

Section: Discussionmentioning

confidence: 99%

Systematic review of cost and cost-effectiveness of different TB-screening strategies

Nienhaus

Schablon

Costa

et al. 2011

BMC Health Serv Res

107

View full text Add to dashboard Cite

show abstract

“…A number of publications suggest it is low [9,27-29]. Because of the high sensitivity of the IGRA and the low specificity of the TST, none of the several national guidelines recommend X-ray or chemoprevention in HCWs with a positive TST and a negative IGRA [20-22]. Therefore it seems reasonable to assume that most TST+/QFT- results do not indicate infection with Mycobacteria tuberculosis .…”

Section: Discussionmentioning

confidence: 99%

“…In order to reduce the effect of BCG vaccination on TST, the French guidelines for TST interpretation propose high cut points for the TST - increase >10 mm or ≥ 15 mm if no earlier TST is available [19]. Alternatively to high cut-offs for TST, a number of European Guidelines on the use of IGRAs suggest use of a two-step strategy - performing an IGRA in those initially positive by the TST and excluding LTBI in those IGRA-negative [20-22]. In our study we compared the performance of the TST and IGRA in French HCWs when using a high cut-off for the TST.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the tuberculin skin test and the interferon-γ release assay for TB screening in French healthcare workers

Tripodi

Brunet-Courtois

Naël

et al. 2009

Journal of Occupational Medicine and Toxicology

View full text Add to dashboard Cite

IntroductionUsing French cut-offs for the Tuberculin Skin Test (TST), results of the TST were compared with the results of an Interferon-γ Release Assay (IGRA) in Healthcare Workers (HCW) after contact to AFB-positive TB patients.MethodsBetween May 2006 and May 2007, a total of 148 HCWs of the University Hospital in Nantes, France were tested simultaneously with IGRA und TST. A TST was considered to indicate recent latent TB infection (LTBI) if an increase of >10 mm or if TST ≥ 15 mm for those with no previous TST result was observed. For those with a positive TST, chest X-ray was performed and preventive chemotherapy was offered.ResultsAll HCWs were BCG-vaccinated. The IGRA was positive in 18.9% and TST ≥ 10 mm was observed in 65.5%. A recent LTBI was believed to be highly probable in 30.4% following TST. Agreement between IGRA and TST was low (kappa 0.041). In 10 (16.7%) out of 60 HCWs who needed chest X-ray following TST the IGRA was positive. In 9 (20%) out of 45 HCWs to whom preventive chemotherapy was offered following TST the IGRA was positive. Of those considered TST-negative following the French guidelines, 20.5% were IGRA-positive. In a two-step strategy - positive TST verified by IGRA - 18 out of 28 (64.3%) IGRA-positive HCWs would not have been detected using French guidelines for TST interpretation.ConclusionThe introduction of IGRA in contact tracings of BCG-vaccinated HCWs reduces X-rays and preventive chemotherapies. Increasing the cut-off for a positive TST does not seem to be helpful to overcome the effect of BCG vaccination on TST.

show abstract

“…In accordance with the national guideline the Interferon-gamma release assay (IGRA) is used for the screening procedures. Early detection and treatment of LTBI are also recommended to prevent progression from latent TB infection to active TB [7]. …”

Section: Introductionmentioning

confidence: 99%

“…These assays, commercially available in the form of QuantiFERON-TB and T-SPOT.TB, have been approved by the US Food and Drug Administration and endorsed in major national guidelines for use instead of or in addition to the TST for LTBI screening [4,7,11,12]. The third generation of the QuantiFERON test (QuantiFERON ® TB Gold In-Tube, QFT-IT) measures in-vitro IFN-γ production by T-cells during in-vitro stimulation with peptides of the M. tuberculosis- specific antigens of the region of difference (RD-1) ESAT-6, CFP-10 and TB7.7.…”

Section: Introductionmentioning

confidence: 99%

Risk of latent TB infection in individuals employed in the healthcare sector in Germany: a multicentre prevalence study

et al. 2010

View full text Add to dashboard Cite

BackgroundHealthcare workers are still recognised as a high-risk group for latent TB infection (LTBI). Therefore, the screening of people employed in the healthcare sector for active and LTBI is fundamental to infection control programmes in German hospitals. It was the aim of the study to determine the prevalence and putative risk factors of LTBI.MethodsWe tested 2028 employees in the healthcare sector with the QuantiFERON-Gold In-tube (QFT-IT) test between December 2005 and May 2009, either in the course of contact tracing or in serial testing of TB high-risk groups following German OSH legislation.ResultsA positive IGRA was found in 9.9% of the healthcare workers (HCWs). Nurses and physicians showed similar prevalence rates (9.7% to 9.6%). Analysed by occupational group, the highest prevalence was found in administration staff and ancillary nursing staff (17.4% and 16.7%). None of the individuals in the trainee group showed a positive IGRA result. In the different workplaces the observed prevalence was 14.7% in administration, 12.0% in geriatric care, 14.2% in technicians (radiology, laboratory and pathology), 6.5% in admission ward staff and 8.3% in the staff of pulmonary/infectious disease wards. Putative risk factors for LTBI were age (>55 years: OR14.7, 95% CI 5.1-42.1), being foreign-born (OR 1.99, 95% CI 1.4-2.8), TB in the individual's own history (OR 4.96, 95% CI 1.99-12.3) and previous positive TST results (OR 3.5, 95% CI 2.4-4.98). We observed no statistically significant association with gender, BCG vaccination, workplace or profession.ConclusionThe prevalence of LTBI in low-incidence countries depends on age. We found no positive IGRA results among trainees in the healthcare sector. Incidence studies are needed to assess the infection risk. Pre-employment screening might be helpful in this endeavour.

show abstract

Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose

Cited by 23 publications

References 21 publications

Systematic review of cost and cost-effectiveness of different TB-screening strategies

Systematic review of cost and cost-effectiveness of different TB-screening strategies

Evaluation of the tuberculin skin test and the interferon-γ release assay for TB screening in French healthcare workers

Risk of latent TB infection in individuals employed in the healthcare sector in Germany: a multicentre prevalence study

Contact Info

Product

Resources

About