Prevalence and risk factors of latent tuberculosis among Korean healthcare workers using whole-blood interferon-γ release assay

Yeon, Jeong Hwa; Seong, Hye; Hur, Ho; Park, Yoonseon; Kim, Young Ah; Han, Chang Hoon; Lee, Sun Min; Seo, Jeong Hun; Kang, Jung Gu

doi:10.1038/s41598-018-28430-w

Cited by 26 publications

(19 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, males had a higher incidence rate of PTB than females, suggesting that males were more likely to suffer from PTB among HCWs than females. It was consistent with the general population and other previous study on HCWs [21,22]. The national TB survey in China also demonstrated that the prevalence of TB in males of all age groups were higher than that in females (p < 0.05) [3].…”

Section: Discussionsupporting

confidence: 91%

Epidemiological characteristics of pulmonary tuberculosis among health-care workers in Henan, China from 2010 to 2017

Wang¹,

Huang

et al. 2020

BMC Infect Dis

View full text Add to dashboard Cite

Background: Health-care workers (HCWs) are an epidemiological group with increased exposure to tuberculosis (TB), especially at health-care facilities (HCFs) with poor TB infection control in high-TB-burden settings. China is a high-TB-burden country, and the comprehensive measures for stopping TB transmission at some HCFs were not implemented well owing to limited resources and other factors. The purpose of this study was to review risk of occupational exposure to TB among HCWs and its change trend, and identify epidemiological characteristics of pulmonary tuberculosis (PTB) among HCWs in Henan, central part of China. Methods: A retrospective cohort study was conducted from 2010 to 2017. All HCWs and teachers in Henan were enrolled to the study as exposed group and non-exposed control group, respectively. Relative risk (RR), attributable risk (AR) and AR percent (AR%) were used to measure the association between the occupational exposure and PTB, and estimated with Poisson regression. Results: The study results showed a total of 1663 cases of PTB were reported among the HCWs in Henan, accounting for 3.2‰ of all PTB cases reported in the whole population, and annual incidence rate of PTB among HCWs declined by 34% from 2010 to 2017. Over the eight years, the incidence rate of PTB among HCWs was 43.7 cases per 100,000 person-years (PYs), significantly higher than that among teachers (18.8 cases/100,000 PYs), and RR, AR and AR% were estimated to 2.3, 24.9 cases per 100,000 PYs and 57%, respectively. Among HCWs, males were more likely to suffer from PTB than females (adjusted RR: 1.3; 95%CI: 1.2-1.4), and HCWs aged under 25 years had the highest relative risk over all age groups with adjusted RR equaling to 8.3 (95%CI: 6.9-9.9) calculated with those aged 45-54 years as the reference. Conclusions: Although overall incidence rate of PTB among HCWs showed decreasing temporal trends over the period of 2010-2017, attributable risk of occupational exposure to TB among HCWs did not decrease in Henan, and TB infection at HCFs for males, young or senior HCWs, especially for young HCWs is of much concern.

show abstract

Section: Discussionsupporting

confidence: 91%

Epidemiological characteristics of pulmonary tuberculosis among health-care workers in Henan, China from 2010 to 2017

Wang¹,

Huang

et al. 2020

BMC Infect Dis

View full text Add to dashboard Cite

show abstract

“…Therefore, many national policies and guidelines recommend that HCWs should be included in LTBI screening programs [56]. The prevalence of LTBI based on analyses using the interferon-gamma release assay (IGRA) is 16–18% for existing HCWs in Korea [78]. Since 2017, in accordance with the Tuberculosis Prevention Act, the government of Korea has paid for LTBI screening and treatment for HCWs [9].…”

Section: Introductionmentioning

confidence: 99%

Screening and Treatment of Latent Tuberculosis Infection among Healthcare Workers at a Referral Hospital in Korea

Park

Lee

et al. 2019

Infect Chemother

View full text Add to dashboard Cite

BackgroundHealthcare workers (HCWs) have a high risk of tuberculosis (TB) infection. Since August 2017, Korea has mandated the testing of latent TB infection (LTBI) and recommended treatment from HCWs at medical institutions. However, the acceptance/completion rate and adverse events of LTBI treatment have not been analyzed.Materials and MethodsFrom February to August 2017, we conducted a retrospective study at a referral university hospital in Korea, to screen the interferon-gamma release assay (IGRA) tests conducted for all HCWs for detecting and treating LTBI. HCWs diagnosed with LTBI were offered a 9-month isoniazid (9H), 3-month isoniazid/rifampin (3HR), or 4-month rifampin regimen. We investigated the acceptance/completion rate, adverse events, and causes of discontinuation or change in LTBI medication. A major adverse event was one wherein a patient had any adverse event ≥grade 3 causing LTBI treatment interruption.ResultsOf the 1,538 HCWs, 1,379 underwent IGRA testing for LTBI. Among them, 13.6% (187/1,379) tested positive and 73.3% (137/187) received treatment. The overall completion rate was 97.8% (134/137). HCWs were significantly more likely to complete first-line therapy with 3HR than with 9H (91.4% vs. 76.7%, P = 0.02). The most common major adverse event was hepatotoxicity (n = 7), followed by thrombocytopenia (n = 1) and anaphylactic shock (n = 1). Hepatotoxicity and hepatotoxicity (≥ grade 2) were more frequent in 9H than in 3HR (39.5% vs. 17.2%, P = 0.006 and 18.6% vs. 3.7%, P = 0.005, respectively). The median time to hepatotoxicity was 96 days (interquartile range, 20 – 103 days).ConclusionCompletion of first-line therapy for LTBI is more likely with 3HR than with 9H. This might be related to the development of hepatotoxicity after around 3 months of treatment. Anaphylactic shock and platelet count should be carefully monitored in those receiving rifampin-containing regimens.

show abstract

“…Accordingly, we identified the distribution of the results, the changes in interpretation and the risks of increasing the degree of QFT-GIT. The positivity rate of the HCWs' initial IGRA test was 13.4%, which is slightly lower than that of 15.8-23.7% in other South Korean studies [17][18][19] and between that of 8.3-22.2% in low TB incidence countries [7-9, 11, 20]. Using the manufacturer's cutoff is simple to interpret but increases conversion and reversion.…”

Section: Discussionmentioning

confidence: 79%

The use of a borderline zone for the interpretation of interferon-gamma release assay results for serial screening of healthcare workers

et al. 2020

View full text Add to dashboard Cite

Objective An interferon-gamma release assay (IGRA) is used to screen for latent tuberculosis infection (LTBI). Among IGRAs, the QuantiFERON-TB Gold In-Tube (QFT-GIT) results are highly variable, so the borderline zone has been proposed to reduce unnecessary LTBI treatment. The aim of this study was to examine the proportion of the borderline zone of QFT-GIT in healthcare workers' (HCWs) serial IGRA and to retrospectively identify the utility of predicting tuberculosis (TB) in a moderate TB incidence setting. Methods The participants were HCWs who had undergone serial LTBI screening between June 2013 and June 2018. IGRA-positive HCWs underwent examinations that included low-dose computed tomography (LDCT) and TB culture, if necessary. Applying the borderline zone (0.2-<0.7 IU/mL), the results were classified as definite negative, borderline negative, borderline positive and definite positive. Results Through the follow-up of 477 HCWs, 441 (92.5%) invariant, 30 (6.3%) conversion, 2 (0.4%) reversion and 5 (1.0%) indeterminate results were observed with the manufacturer's cutoff. Applying the borderline zone, 419 (87.8%) invariant, 22 (4.6%) conversion, 1 (0.2%) reversion and 36 (7.5%) decision pending, including 5 (1.0%) indeterminate results, were observed. At the time of screening, five TB cases were identified. Chest X-ray (CXR) identified one TB case, and LDCT identified four additional TB cases. After one year, two TB cases were diagnosed, and their screening QFT-GIT results were definite positive and borderline negative. In the Cochran-Armitage trend test, the greater the maximum difference in

show abstract

Prevalence and risk factors of latent tuberculosis among Korean healthcare workers using whole-blood interferon-γ release assay

Cited by 26 publications

References 14 publications

Epidemiological characteristics of pulmonary tuberculosis among health-care workers in Henan, China from 2010 to 2017

Epidemiological characteristics of pulmonary tuberculosis among health-care workers in Henan, China from 2010 to 2017

Screening and Treatment of Latent Tuberculosis Infection among Healthcare Workers at a Referral Hospital in Korea

The use of a borderline zone for the interpretation of interferon-gamma release assay results for serial screening of healthcare workers

Contact Info

Product

Resources

About