Screening for Tuberculosis in Health Care Workers: Experience in an Italian Teaching Hospital

Napoli, Christian; Ferretti, Filippo; Ninno, Filippo Di; Orioli, Riccardo; Marani, Alessandra; Sarlo, Maria Giuditta; Prestigiacomo, Claudio; Luca, Assunta De; Orsi, Giovanni Battista

doi:10.1155/2017/7538037

Cited by 15 publications

(15 citation statements)

References 24 publications

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“…The lack of immunization with the BCG vaccine was independently associated with LTBI, which is in line with some findings from several studies on the effectiveness of the protection afforded by the BCG vaccine against TB and LTBI . However, there is still much to learn about appropriate BCG vaccine strategies because of conflicting reports on the efficacy of BCG .…”

Section: Discussionsupporting

confidence: 79%

First assessment of interferon gamma release assay results among healthcare workers at a general hospital in China

Guo

Jiang

Liu

et al. 2018

Clinical Respiratory J

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Introduction China has a very high tuberculosis (TB) burden. The interferon‐gamma release assay (IGRA) is more specific for the diagnosis of latent tuberculosis infection (LTBI) than the tuberculin skin test, especially among populations with a high degree of coverage by the BCG vaccine. Objectives To evaluate the first screening of healthcare workers (HCW) for LTBI using the IGRA at a general hospital in Beijing. Methods A pilot screening program for LTBI was triggered by accidental contact between HCW and two patients with active TB in the emergency department (ED). Given the necessity of estimating the overall LTBI prevalence in the institution, a sample of 518 HCW was enrolled in our cross‐sectional study. The second IGRA was repeated with 43 of the 121 HCW in the ED after exposure to index TB cases. Data on putative risk factors were collected with a self‐administered questionnaire. Results The prevalence of LTBI in the targeted population was 21.8%. Differences in the prevalence of LTBI were significantly related to age, employment duration, and history of occupational exposure. A lack of childhood BCG vaccination was independently associated with the prevalence of LTBI (adjusted OR: 1.686, 95% CI: 1.045‐2.723, P = .0325). No new LTBI was diagnosed 12 weeks postexposure. No HCW adopted the preventive treatment for LTBI. Conclusions Considering the high morbidity of LTBI among HCW even in general hospitals, it is essential to formulate government policies and institutional operation protocols for the systematic screening, registration, and administration of prophylaxes for the control of LTBI.

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Section: Discussionsupporting

confidence: 79%

First assessment of interferon gamma release assay results among healthcare workers at a general hospital in China

Guo

Jiang

Liu

et al. 2018

Clinical Respiratory J

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“…18 A study from Rome, Italy witnessed low LTBI burden 16.1% in a teaching hospital. 8 Despite being a high-risk group, the exposure of healthcare workers to TB in Pakistan has not been studied earlier which is one of the advantages of the present study. Furthermore, we have highlighted the risk of occupational exposure of HCWs to tuberculosis infection.…”

Section: Discussionmentioning

confidence: 94%

“…No other population subgroup is more highly exposed to multi-drug resistant tuberculosis (MDR) than healthcare workers and thus, have sixfold risk to contact MDR tuberculosis. 8 While the significance of LTBI detection cannot be overemphasized, there is no gold standard test for its diagnosis. The quantity of Mycobacterium tuberculosis in LTBI patients is minimal.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of latent tuberculosis infection in healthcare workers in tertiary care hospitals of Pakistan

Sadaf

Munir²,

Farrukh

et al. 2019

Pak J Med Sci

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Objective: To determine the prevalence of latent tuberculosis infection (LTBI) in healthcare workers in tertiary care hospitals of Rawalpindi, using interferon gamma release assay. Methods: It was a cross-sectional study. The samples were collected from pulmonology and microbiology departments of three hospitals; i) Military Hospital, Rawalpindi, ii) Fauji Foundation Hospital, Rawalpindi and iii) Pakistan Institute of Medical Sciences, Islamabad. The study was completed in one year from January 2017 to January 2018. Fifty-five asymptomatic healthcare workers of both genders between the ages of 18-50 years with a working tenure of at least one year in concerned departments were included and those with active tuberculosis were excluded from the study. Whole blood from subjects was collected and plasma was checked for interferon gamma value by IGRA(Interferon gamma release assay). Results: In this study of total 55 healthcare workers a high prevalence 22 (40.0%) of latent tuberculosis was found. When LTBI distribution was analyzed within occupational categories, the most frequently affected were sanitary workers 3 (100.0%), nurses 5 (50.0%), doctors 6 (43%) and nursing assistants 2 (40%). Conclusion: The prevalence of LTBI in healthcare workers is alarmingly high in our local healthcare settings. doi: https://doi.org/10.12669/pjms.36.2.936 How to cite this:Sadaf R, Munir T, Farrukh S, Abbasi S. Prevalence of latent tuberculosis infection in healthcare workers in tertiary care hospitals of Pakistan. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.936 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…According to this strategy, the IGRA test has a central role as a TB second step-screening, in order to reduce the number of people that should undergo more invasive tests (X-ray diagnosis and/or chemotherapy). TST followed by QFT was particularly cost-effective when the rate of LTBI in the screened population was low [23,24].…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Annual Screening for Tuberculosis among Italian Healthcare Workers: A Retrospective Study

Coppeta

Somma

Baldi

et al. 2020

IJERPH

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Background. In the past few years, healthcare workers (HCWs) have been considered at higher risk for tuberculosis (TB) infection than the general population. On the other hand, recent studies have reported a low conversion rate among these workers. Recently, the Center for Disease Control (CDC) updated its recommendations, suggesting that an annual screening should not be performed in the absence of a documented exposure but only in workers with high-risk duties or with job tasks in settings at high risk of tuberculosis contagion (e.g., departments of infectious or pulmonary diseases). In fact, some studies showed that annual tuberculosis screening for all the HCWs was not cost-effective in countries with a low incidence of TB. In this study, we evaluated the conversion rate and the cost-effectiveness of two different tuberculosis screening strategies in a large population of Italian HCWs. Methods. In our retrospective study, we reviewed data coming from a tuberculosis screening conducted on 1451 HCWs in a teaching hospital of Rome. All workers were evaluated annually by means of the Quantiferon test (QFT) for a five-year period. Then, the conversion rate was calculated. Results. We found a cumulative conversion rate of 0.6%. Considering the cost of the QFT test (48.26 euros per person), the screening of the HCWs resulted in a high financial burden (38,902.90 euros per seroconversion). Only one seroconversion would have been missed by applying the CDC updated recommendations, with a relevant drop of the costs: 6756.40 euros per seroconversion, with a global save of 296,075.10 euros. Conclusion: The risk of TB conversion among our study population was extremely low and it was related to the risk classification of the setting. Giving these results, the annual tuberculosis screening appeared to not be cost effective. We conclude that a targeted screening would be a better alternative in HCWs with a higher risk of TB exposure.

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Screening for Tuberculosis in Health Care Workers: Experience in an Italian Teaching Hospital

Cited by 15 publications

References 24 publications

First assessment of interferon gamma release assay results among healthcare workers at a general hospital in China

First assessment of interferon gamma release assay results among healthcare workers at a general hospital in China

Prevalence of latent tuberculosis infection in healthcare workers in tertiary care hospitals of Pakistan

Cost-Effectiveness of Annual Screening for Tuberculosis among Italian Healthcare Workers: A Retrospective Study

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