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Screening for Tuberculosis Infection Using Whole-Blood Interferon-γ and Mantoux Testing Among Japanese Healthcare Workers

Published online by Cambridge University Press:  21 June 2016

Nobuyuki Harada ,
Yutsuki Nakajima ,
Kazue Higuchi ,
Yukie Sekiya ,
Jim Rothel  and
Toru Mori
Nobuyuki Harada*
Affiliation:
Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
Yutsuki Nakajima
Affiliation:
Fukujuji Hospital, Japan Anti-Tuberculosis Association, Tokyo, Japan National Hospital Organization, Kitasato University, Tokyo, Japan
Kazue Higuchi
Affiliation:
Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan
Yukie Sekiya
Affiliation:
Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan Laboratory of Immunoregulation, Kitasato Institute for Life Science, Kitasato University, Tokyo, Japan
Jim Rothel
Affiliation:
Cellestis, Carnegie, Australia
Toru Mori
Affiliation:
Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Tokyo, Japan Leprosy Research Center, National Institute of Infections Diseases, Tokyo, Japan
*
Immunology Division, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, 3-1-24, Matsuyama, Kiyose, Tokyo 204-8533, Japan ([email protected])
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Abstract

Objective.

To examine the hypothesis that results of the QuantiFERON-TB Gold assay (QFT-G), a whole-blood test for detection of tuberculosis infection, are more significantly related to known risk factors for tuberculosis infection in healthcare workers (HCWs) who have received bacille Calmette-Guerin vaccine than are results of the Mantoux tuberculin skin test (TST).

Design.

All HCWs (approximately 510) from a 370-bed general hospital in Tokyo where patients with and patients without tuberculosis are treated were invited to participate in the study. All study participants completed a questionnaire about their Mycobacterium tuberculosis infection risk factors as HCWs at the general hospital. They were then tested for LTBI by means of the QFT-G, followed by the TST. Statistical analyses were performed to compare results of each test with M. tuberculosis infection risk factors (age, length of employment in the healthcare industry, history of working with tuberculosis-positive patients in a tuberculosis ward or in the outpatient department of the hospital's tuberculosis clinic for more than 1 year, chest radiograph evidence of healed tuberculosis, history of performing bronchoscope procedures, and job classification), and for TST-positive HCWs, to compare the QFT-G result with the TST induration diameter.

Results.

A total of 332 HCWs (95% of whom had been vaccinated with BCG) participated in the study, and 33 had positive QFT-G results, suggesting a prevalence of LTBI of 9.9%. Of 304 HCWs who underwent TST, 283 (93.1%) had an induration diameter of 10 mm or more. Multiple logistic regression analysis revealed that positive QFT-G results were significantly associated with age and with a history of working in a tuberculosis ward or an outpatient department of a tuberculosis clinic. TST results were not correlated with any of the tuberculosis infection risk factors we evaluated.

Conclusions.

Positive QFT-G results were closely associated with the presence of risk factors for LTBI in a hospital setting, suggesting that the QFT-G can detect LTBI in a population composed predominately of BCG vaccinees. Because most HCWs worldwide have been vaccinated with BCG, the QFT-G offers a significant improvement over the TST in tuberculosis screening programs and minimizes un-warranted use of tuberculosis prophylaxis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 5 , May 2006 , pp. 442 - 448
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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