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Interferon-γ Release Assay vs. Tuberculin Skin Test for Tuberculosis Screening in Exposed Healthcare Workers: A Longitudinal Multicenter Comparative Study

Published online by Cambridge University Press:  16 February 2015

Jean-Christophe Lucet ,
Dominique Abiteboul ,
Candice Estellat ,
Carine Roy ,
Sylvie Chollet-Martin ,
Florence Tubach ,
Guislaine Carcelain  and
and the QUANTIPS Study Group
Jean-Christophe Lucet*
Affiliation:
AP-HP, Bichat-Claude Bernard Hospital, Infection Control Unit, F-75018 Paris, France Université Paris Diderot, IAME, UMR 1137, F-75018 Paris, France
Dominique Abiteboul
Affiliation:
AP-HP, Bichat-Claude Bernard Hospital, Department of Occupational Health, F-75018 Paris, France
Candice Estellat
Affiliation:
AP-HP, Bichat-Claude Bernard Hospital, Département d’Epidémiologie et Recherche Clinique, URC Paris-Nord, F-75018 Paris, France INSERM, CiC-EC 1425, F-75018 Paris, France AP-HP, Bichat-Claude Bernard Hospital, Unité d’Immunologie “Auto-immunité et Hypersensibilités”, F-75018 Paris, France
Carine Roy
Affiliation:
AP-HP, Bichat-Claude Bernard Hospital, Département d’Epidémiologie et Recherche Clinique, URC Paris-Nord, F-75018 Paris, France INSERM, CiC-EC 1425, F-75018 Paris, France
Sylvie Chollet-Martin
Affiliation:
AP-HP, Bichat-Claude Bernard Hospital, Unité d’Immunologie “Auto-immunité et Hypersensibilités”, F-75018 Paris, France INSERM UMRS996, Université Paris-Sud, France
Florence Tubach
Affiliation:
AP-HP, Bichat-Claude Bernard Hospital, Département d’Epidémiologie et Recherche Clinique, URC Paris-Nord, F-75018 Paris, France INSERM, CiC-EC 1425, F-75018 Paris, France Sorbonne Universités, UPMC Univ Paris 06, CIMI - Paris, F-75013, France
Guislaine Carcelain
Affiliation:
Univ Paris Diderot, Sorbonne Paris Cité, ECEVE, UMR1123, Paris, F-75010France Inserm, U1135, CIMI, Paris, Paris, F-75013, France AP-HP, Hôpital Pitié-Salpêtrière, Département d’Immunologie, Paris, F-75013, France
*
Address all correspondence to Jean-Christophe Lucet, Hôpital Bichat-Claude Bernard, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard 75018 Paris, France ([email protected]).
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Abstract

OBJECTIVE

Healthcare workers (HCWs), especially those caring for patients with tuberculosis (TB), are at high risk of acquiring that disease. The poor specificity of tuberculin skin testing (TST) prompted us to evaluate the effectiveness of the interferon-γ release assay (IGRA) in comparison with TST in a large prospective, multicenter, 1-year study of HCWs with occupational exposure to TB.

METHODS

HCWs from high-risk units at 14 university hospitals were invited to participate and underwent both TST and IGRA (first Quantiferon TB Gold-IT®, QFT-G, then T-SPOT.TB® if QFT-G was indeterminate) at baseline and after 1 year. We collected demographic characteristics, country of birth, history of TB, immunosuppression, past exposure to TB, history of BCG vaccination, results of most recent TST, job category, and duration of current function.

RESULTS

Among 807 HCWs enrolled, current or past TST at baseline was positive (≥15 mm) in 282 (34.9%); the IGRA was positive in 113 (14.0%) and indeterminate in 3 (0.4%). After 1 year, 594 HCWs had both an IGRA and TST (or prior TST≥15 mm) at baseline and an IGRA and TST (if indicated). The conversion rate was 2.5% (9 of 367) with TST and 7.6% (45 of 594) with IGRA, with poor agreement between the 2 tests. Using only QFT-G, conversion (9.9%) and reversion (17.8%) rates were higher for baseline QFT-G positive quantitative values <1 IU/mL.

CONCLUSION

TST and the IGRA yielded discordant results. The value of IGRA in addition to TST remains undetermined; the two should be jointly interpreted in decision-making (clinical trial registration NCT00797836).

Infect Control Hosp Epidemiol 2015;00(0): 1–6

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 5 , May 2015 , pp. 569 - 574
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

The QUANTIPS Study Group: B Ripault, P Rucay, A Chevallier (Hôpital universitaire, Angers), MF Maillard, D Emilie, A Gleaize (Hôpital Antoine Béclère, Clamart), D Abiteboul, F Brégent, S Chollet-Martin, P Nicaise (Hôpital Bichat-Cl. Bernard, Paris), C Pillier-Loriette, Y Taoufik, H Chavez (Hôpital Bicêtre, le Kremlin-Bicètre), A Sobazeck, A Trichard, M Labalette (Hôpital univesitaire, Lille) M Brabet, J-P Vendrell, E Tuaillon (Hôpital universitaire, Montpellier), V Naël, D Tripodi, M Audrain (Hôpital universitaire, Nantes), ML Lepori, AS Wasmer, G Faure, M De Carvalho (Hôpital universitaire, Nancy), N Coullaud, C Capitaine, E Ritter, S Benzaken (Hôpital universitaire, Nice), M Louet, F Désert (Hôpital Pitié-Salpetrière, Paris), G Coulombier, JM Gombert et A Barra (Hôpital universitaire, Poitiers), M Courgeon, C Vialard, B Sorel, C Laguitton, N Genetet et D Monnier (Hôpital universitaire, Rennes), M Bourgeois, M.A Touat, C Rabian (Hôpital Saint Louis, Paris), P Ochin (Hôpital Universitaire, Tourcoing)

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