Skip to main content Accessibility help
×
Home

Annual Incidence of Latent Tuberculosis Infection among Newly Employed Nurses at a Tertiary Care University Hospital

  • Kwangha Lee (a1), Min Kyoung Han (a2), Hye Ran Choi (a2), Chang-Min Choi (a1), Yeon-Mok Oh (a1), Sang Do Lee (a1), Woo Sung Kim (a1), Dong Soon Kim (a1), Jun Hee Woo (a2) and Tae Sun Shim (a1)...

Abstract

Objective.

To investigate the annual rate of tuberculosis (TB) infection among newly employed nurses using both tuberculin skin test (TST) and QuantiFERON-TB Gold (QFT-G; Cellestis Limited) assay.

Design.

A prospective cohort study involving newly employed nurses.

Setting.

A tertiary care university hospital in South Korea.

Methods.

All participants (n = 196) were tested with the TST and QFT-G assay at baseline. After 1 year, the TST and QFT-G assay were reperformed for subjects who had negative TST results at baseline and for all subjects, respectively.

Results.

The baseline TST and QFT-G assays were positive for 101 subjects (51.5%) and 28 subjects (14.3%), respectively; 22 subjects (11.2%) had positive results of both tests. Although the overall between-test agreement was 54.9% (κ = 0.151 [95% confidence interval, 0.047–0.245]), agreement improved to 78.5% (κ = 0.462 [95% confidence interval, 0.007–0.917]) for subjects who had not received bacille Calmette-Guérin vaccination. After 1 year, the TST yielded positive results for 16 (21.3%) of 75 nurses with negative baseline results, and the QFT-G assay yielded positive results for 21 (14.4%) of 146 subjects with negative baseline Results. Collectively, 5 subjects (3.0%) experienced conversion to positive results with both tests, and 32 subjects (18.9%) experienced conversion to positive results with one of the tests. Neither the employing hospital department nor exposure to patients with TB affected test conversion status.

Conclusions.

The poor overall agreement between TST and QFT-G results may have been caused by the confounding effect of bacille Calmette-Guérin vaccination. The annual risk of TB infection among newly employed nurses was at least 3% on the basis of results of both the TST and QFT-G test. Stricter preventive strategies against TB spread should be implemented in our hospital.

Copyright

Corresponding author

Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea (shimts@amc.seoul.kr)
Department of Infection Control, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-2 dong, Songpa-gu, Seoul, 138-736, Korea (junheewoo@amc.seoul.kr)

References

Hide All
1.Menzies, D, Joshi, R, Pai, M. Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis 2007;11:593605.
2.Harada, N, Nakajima, Y, Higuchi, K, Sekiya, Y, Rothel, J, Mori, T. Screening for tuberculosis infection using whole-blood interferon-gamma and Mantoux testing among Japanese healthcare workers. Infect Control Hosp Epidemiol 2006;27:442448.
3.Joshi, R, Reingold, AL, Menzies, D, Pai, M. Tuberculosis among healthcare workers in low- and middle-income countries: a systematic review. PLoS Med 2006;3:e494.
4.Menzies, D. Interpretation of repeated tuberculin tests: boosting, conversion, and reversion. Am J Respir Crit Care Med 1999;159:1521.
5.Mazurek, GH, LoBue, PA, Daley, CL, et al.Comparison of a whole-blood interferon gamma assay with tuberculin skin testing for detecting latent Mycobacterium tuberculosis infection. JAMA 2001;286:17401747.
6.Wang, L, Turner, MO, Elwood, RK, Schulzer, M, FitzGerald, JM. A metaanalysis of the effect of bacille Calmette Guerin vaccination on tuberculin skin test measurements. Thorax 2002;57:804809.
7.Mazurek, GH, Villarino, ME. Guidelines for using the QuantiFERON-TB test for diagnosing latent Mycobacterium tuberculosis infection. Centers for Disease Control and Prevention. MMWR Recomm Rep 2003;52:1518.
8.Menzies, R, Vissandjee, B. Effect of bacille Calmette-Guerin vaccination on tuberculin reactivity. Am Rev Respir Dis 1992;145:621625.
9.Skjot, RL, Oettinger, T, Rosenkrands, I, et al.Comparative evaluation of low-molecular-mass proteins from Mycobacterium tuberculosis identifies members of the ESAT-6 family as immunodominant T-cell antigens. Infect Immun 2000;68:214220.
10.Behr, MA, Wilson, MA, Gill, WP, et al.Comparative genomics of BCG vaccines by whole-genome DNA microarray. Science 1999;284:15201523.
11.Pai, M, Riley, LW, Colford, JM Jr.Interferon-gamma assays in the immu-nodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis 2004;4:761776.
12.Menzies, D, Pai, M, Comstock, G. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med 2007;146:340354.
13.Pai, M, Zwerling, A, Menzies, D. Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med 2008;149:177184.
14.Hong, YP, Kim, SJ, Lew, WJ, Lee, EK, Han, YC. The seventh nationwide tuberculosis prevalence survey in Korea, 1995. Int J Tuberc Lung Dis 1998;2:2736.
15.Lew, WJ, Lee, EG, Bai, JY, et al.An Internet-based surveillance system for tuberculosis in Korea. Int J Tuberc Lung Dis 2006;10:12411247.
16.Kang, YA, Lee, HW, Yoon, HI, et al.Discrepancy between the tuberculin skin test and the whole-blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA 2005;293:27562761.
17.Lee, SS, Liu, YC, Huang, TS, et al.Comparison of the interferon-gamma release assay and the tuberculin skin test for contact investigation of tuberculosis in BCG-vaccinated health care workers. Scand J Infect Dis 2008;40:373380.
18.Nienhaus, A, Schabion, A, Bacie, CL, Siano, B, Diel, R. Evaluation of the interferon-gamma release assay in healthcare workers. Int Arch Occup Environ Health 2008;81:295300.
19.Jo, KW, Woo, JH, Hong, Y, et al.Incidence of tuberculosis among health care workers at a private university hospital in South Korea. Int J Tuberc Lung Dis 2008;12:436440.
20.Jung, YJ, Park, IN, Hong, SB, et al.The clinical characteristics, diagnosis, treatment, and outcomes of patients with tuberculosis at a private university hospital in Korea. Tuberc Respir Dis 2006;60:194204.
21.American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161: S221247.
22.Sokal, JE. Measurement of delayed skin-test responses. N Engl J Med 1975;293:501502.
23.Mori, T, Sakatani, M, Yamagishi, F, et al.Specific detection of tuberculosis infection: an interferon-gamma-based assay using new antigens. Am J Respir Crit Care Med 2004;170:5964.
24.Brock, I, Weldingh, K, Lillebaek, T, Follmann, F, Andersen, P. Comparison of tuberculin skin test and new specific blood test in tuberculosis contacts. Am J Respir Crit Care Med 2004;170:6569.
25.Pollock, NR, Campos-Neto, A, Kashino, S, et al.Discordant QuantiFERON-TB Gold test results among US healthcare workers with increased risk of latent tuberculosis infection: a problem or solution? Infect Control Hosp Epidemiol 2008;29:878886.
26.Mazurek, GH, Jereb, J, Lobue, P, Iademarco, MF, Metchock, B, Vernon, A. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep 2005;54:4955.
27.Pai, M, O'Brien, R. Serial testing for tuberculosis: can we make sense of T cell assay conversions and reversions? PLoS Med 2007;4:e208.
28.Jensen, PA, Lambert, LA, Iademarco, MF, Ridzon, R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005;54:1141.
29.Pai, M, Joshi, R, Dogra, S, et al.T-cell assay conversions and reversions among household contacts of tuberculosis patients in rural India. Int J Tuberc Lung Dis 2009;13:8492.
30.Pai, M, Joshi, R, Dogra, S, et al.Serial testing of health care workers for tuberculosis using interferon-gamma assay. Am J Respir Crit Care Med 2006;174:349355.
31.Veerapathran, A, Joshi, R, Goswami, K, et al.T-cell assays for tuberculosis infection: deriving cut-offs for conversions using reproducibility data. PLoS ONE 2008;3:e1850.
32.van Zyl-Smit, RN, Pai, M, Peprah, K, et al.Within-subject variability and boosting of T cell IFN-y responses following tuberculin skin testing. Am J Respir Crit Care Med 2009;180:4958.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed