Hostname: page-component-7c8c6479df-ph5wq Total loading time: 0 Render date: 2024-03-29T06:08:17.728Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  02 January 2015

Kwangha Lee
Affiliation:
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Min Kyoung Han
Affiliation:
Department of Infectious Control, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Hye Ran Choi
Affiliation:
Department of Infectious Control, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Chang-Min Choi
Affiliation:
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Yeon-Mok Oh
Affiliation:
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Sang Do Lee
Affiliation:
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Woo Sung Kim
Affiliation:
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Dong Soon Kim
Affiliation:
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Jun Hee Woo*
Affiliation:
Department of Infectious Control, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
Tae Sun Shim*
Affiliation:
Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
*
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)
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)

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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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.Google Scholar
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.Google Scholar
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.Google Scholar
4.Menzies, D. Interpretation of repeated tuberculin tests: boosting, conversion, and reversion. Am J Respir Crit Care Med 1999;159:1521.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
8.Menzies, R, Vissandjee, B. Effect of bacille Calmette-Guerin vaccination on tuberculin reactivity. Am Rev Respir Dis 1992;145:621625.Google Scholar
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.Google Scholar
10.Behr, MA, Wilson, MA, Gill, WP, et al.Comparative genomics of BCG vaccines by whole-genome DNA microarray. Science 1999;284:15201523.Google Scholar
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google Scholar
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.Google ScholarPubMed
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.Google Scholar
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.Google Scholar
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.CrossRefGoogle Scholar
21.American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161: S221247.Google Scholar
22.Sokal, JE. Measurement of delayed skin-test responses. N Engl J Med 1975;293:501502.Google Scholar
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.Google Scholar
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar
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.Google ScholarPubMed
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.Google Scholar
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
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.Google Scholar