Safety of the two-step tuberculin skin test in Indian health care workers

Christopher, Devasahayam Jesudas; Shankar, Deepa; Datey, Ashima; Zwerling, Alice; Pai, Madhukar

doi:10.1016/j.ijmyco.2014.10.004

Cited by 10 publications

(5 citation statements)

References 13 publications

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“…Eighteen studies representing 10,078 subjects from seven high burden countries were included: one from Bangladesh [ 31 ], six from Brazil [ 22 , 32 – 36 ], five from China [ 4 , 37 – 40 ], two from India [ 41 , 42 ], two from South Africa [ 43 , 44 ], one from Uganda [ 45 ] and one from Zimbabwe [ 20 ] ( Table 1 ). These studies were conducted during 2001–2014 and published during 2005–2015.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of Latent Tuberculosis among Health Care Workers in High Burden Countries: A Systematic Review and Meta-Analysis

2016

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BackgroundTuberculosis is one of the leading causes of death worldwide. Twenty-two high burden countries contributed to the majority of worldwide tuberculosis cases in 2015. Health care workers are at high risk of acquiring tuberculosis through occupational exposure.ObjectiveTo estimate the prevalence of latent tuberculosis infection (LTBI) among health care workers in high burden countries.MethodsDatabases including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (Ovid) and ISI Web of Science (Thompson-Reuters), and grey literature were searched for English language records on relevant medical subject headings (MeSH) terms of LTBI and health care providers. Literature was systematically reviewed using EPPI-Reviewer4 software. Prevalence and incidence of LTBI and 95% confidence intervals (CI) were reported. Pooled prevalence of LTBI and 95% CI were calculated using random-effects meta-analysis models and heterogeneity was assessed using I2 statistics. Sub-group analysis was conducted to assess the cause of heterogeneity.ResultsA total of 990 records were identified. Of those, 18 studies from only 7 high burden countries representing 10,078 subjects were included. Tuberculin skin test results were available for 9,545 participants. The pooled prevalence of LTBI was 47% (95% CI 34% to 60%, I2 = 99.6%). In subgroup analyses according to the country of the study, the pooled prevalence of LTBI was lowest in Brazil (37%) and highest in South Africa (64%). The pooled prevalence of LTBI among medical and nursing students was 26% (95% CI 6% to 46%, I2 = 99.3%) while the prevalence among all types of health care workers was 57% (95% CI 44% to 70%, I2 = 99.1%). Incidence of LTBI was available for health care workers in four countries. The cumulative incidence ranged from 2.8% in Brazilian medical students to 38% among all types of health care workers in South Africa.ConclusionThe findings of this study suggest that there is a high burden of LTBI among health care workers in high burden countries. Adequate infection control measures are warranted to prevent and control transmission in health care settings.

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Section: Resultsmentioning

confidence: 99%

Prevalence of Latent Tuberculosis among Health Care Workers in High Burden Countries: A Systematic Review and Meta-Analysis

2016

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“…( 15) It was mentioned in previous studies that two-step TST to be done over healthcare settings rather we did only single-step TST. (24) A better measure to assess the association of the number of exposures to risk of LTBI would be to obtain real-time data on exposure rather than collect annual data as recommended by the CDC, which is subject to recall bias. Finally, we did not collect information on how much time was spent in the wards and clinics or the number of encounters with active TB patients, thus potentially underestimating the association of exposure with incident LTBI…”

Section: Discussionmentioning

confidence: 99%

To study the prevalence of latent tuberculosis infection among medical students

Dinkar

Kumar

et al. 2022

Indian J Community Health

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Background: Risk of developing latent tuberculosis infection increases in medical students with their higher exposure to TB care facilities. Objective: To study the prevalence of latent TB infection among students attending professional degrees MBBS, BDS, MD, MS, MDS at King George’s Medical University, India. Methods: This study was carried out with Tuberculin skin testing among students and active TB cases were excluded. A standard dose of 0.1?mL of purified protein derivative was slowly injected intra dermally into non-dominant forearm. After 48-72 hours, the reaction was estimated by measuring the transverse diameter of the induration. Results: Total 561 students had given consent to get enrolled. Prevalence of latent tuberculosis infection was significant with period of clinical exposure (p-value < 0.05), average size of induration (p-value < 0.001), and history of prior Tuberculin Skin Test (p-value < 0.001). However it was not significant with the age (p-value > 0.05), gender (p-value > 0.05), and history of contact with active cases of TB (p-value > 0.05). Conclusion: The prevalence of latent tuberculosis infection is higher in post graduate students followed by interns and final year students due to more exposure to patients in wards and clinics at King George’s Medical University, India.

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“…Our protocol is also safer and more ethically acceptable. Tuberculin injection, although generally well tolerated, can cause local adverse reactions such as itching, pain, blistering, a necrotic reaction and vagal malaise 28 . Saline injection is safe despite mild temporary local discomfort, usually a burning sensation.…”

Section: Discussionmentioning

confidence: 99%

A simple protocol for tuberculin skin test reading certification

et al. 2021

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Although tuberculosis preventive therapy is one of the cornerstones for eliminating the disease, many barriers exist in the cascade of care for latent tuberculosis infection, including the need to certify healthcare professionals for reading tuberculin skin tests (TST). This paper proposes and evaluates a simple protocol for TST reading training. Primary care workers from different backgrounds received a 2-hour theoretical course, followed by a practical course on bleb reading. Blebs were obtained by injecting saline into sausages and then in volunteers. A certified trainer then evaluated the effectiveness of this protocol by analyzing the trainees’ ability to read TST induration in clinical routine, blinded to each other’s readings. Interobserver agreement was analyzed using the Bland-Altman test. The trainees’ reading accuracy was calculated using two cut-off points - 5 and 10mm - and the effect of the number of readings was analyzed using a linear mixed model. Eleven healthcare workers read 53 saline blebs and 88 TST indurations, with high agreement for TST reading (0.07mm average bias). Sensitivity was 100% (94.6; 100.0) at 5mm cut-off and 87.3% (75.5; 94.7) at 10mm cut-off. The regression model found no effect of the number of readings [coefficient: -0.007 (-0.055; 0.040)]. A simple training protocol for reading TST with saline blebs simulations in sausages and volunteers was sufficient to achieve accurate TST induration readings, with no effect observed for the number of readings. Training with saline blebs injected into voluntary individuals is safer and easier than the traditional method.

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Safety of the two-step tuberculin skin test in Indian health care workers

Abstract: Screening of HCWs with two-step TST for LTBI is simple and safe, and hence suitable for wide scale implementation in high-burden settings such as India.

Cited by 10 publications

References 13 publications

Prevalence of Latent Tuberculosis among Health Care Workers in High Burden Countries: A Systematic Review and Meta-Analysis

Prevalence of Latent Tuberculosis among Health Care Workers in High Burden Countries: A Systematic Review and Meta-Analysis

To study the prevalence of latent tuberculosis infection among medical students

A simple protocol for tuberculin skin test reading certification

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