Contact investigation in a primary school using a whole blood interferon-gamma assay

Higuchi, Kazue; Kondo, Shuji; Wada, Masako; Hayashi, Sawako; Ootsuka, Gorou; Sakamoto, Noboru; Harada, Nobuyuki

doi:10.1016/j.jinf.2009.02.019

Cited by 30 publications

(10 citation statements)

References 24 publications

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“…Although the negative and positive predictive values of IGRAs remain to be proven definitively, the findings presented in several recent publications show that progression to active TB occurred only in subjects with a positive IGRA result at the time of screening, while TB did not occur in those with negative test results (1,11,16). A study for which the association was less clear was conducted with exposed and mostly treated children in Turkey, where reinfections may be more common (6).…”

mentioning

confidence: 99%

Kinetics of a Tuberculosis-Specific Gamma Interferon Release Assay in Military Personnel with a Positive Tuberculin Skin Test

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Bauwens

Schlösser

et al. 2010

Clin Vaccine Immunol

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Treatment of latentEach year, about 3,000 Dutch army personnel are deployed to regions where tuberculosis (TB) is highly endemic. Screening of military personnel for latent Mycobacterium tuberculosis infection (LTBI) has thus far been based on the tuberculin skin test (TST). The Netherlands is a country with a low prevalence of TB, with a yearly incidence of 5.9 cases/100,000 population in 2007, only one-third of which occurred among native Dutch persons (Tuberculosis in The Netherlands 2007 [www.kncvtbc .nl]). Personnel are screened by the TST upon initial recruitment into the army, after deployment, or in the presence of other risk factors for TB exposure. Military personnel with TST conversion are prescribed isoniazid for 6 months to prevent TB disease. The risk of progression from untreated LTBI to active TB is generally believed to be about 10%, with half of the cases occurring within 2 years after infection. However, the risks observed in different studies comparing subjects treated with isoniazid or placebo varied widely, depending on the setting and the characteristics of the study population (38). A major disadvantage of the current policy is that a substantial proportion of TST conversions in this setting are thought to be caused by exposure to nontuberculous mycobacteria (NTM), skewing the risk-benefit ratio of preventive treatment (8). In addition, increasing proportions of the Dutch population and Dutch military recruits originate from countries where M. bovis BCG vaccination is routinely used. In BCG-vaccinated Dutch military personnel or those with a previous positive TST result, TST is not performed, as a rule, and chest radiography is used as an alternative, but radiography lacks sensitivity for the detection of LTBI. Finally, a positive TST result often remains positive, thus precluding the detection of reinfection.In order to overcome the disadvantages of the TST, gamma interferon (IFN-␥) release assays (IGRAs) that use M. tuberculosis-specific antigens and that are not affected by BCG and most NTM were developed (2-4, 32, 34). In contact investigations, the results of IGRAs had a better correlation with measures of exposure (5,19,21,43). Since 2005, IGRAs have increasingly been used for the detection of LTBIs either as a replacement of or as adjunct to the TST (18,26,28). Of the two presently commercially available IGRAs, the Quantiferon TB Gold In-Tube assay (QFT-Git) is a robust whole-bloodbased test suitable for use for large-scale testing (5,7,22). In a previous study, QFT-Git was positive for only a minority of military personnel with a positive TST result after deployment (13). Those results were considered to be related to NTM exposure, in accordance with the high proportion of falsepositive TST responses assessed by dual skin testing of army recruits by the use of tuberculin and atypical sensitin (8). The destinations of deployment at the time of the earlier study were mainly Iraq and Bosnia (13), but the destination has changed to Afghanistan in the past few years. As the incidence o...

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confidence: 99%

Kinetics of a Tuberculosis-Specific Gamma Interferon Release Assay in Military Personnel with a Positive Tuberculin Skin Test

Brummelen

Bauwens

Schlösser

et al. 2010

Clin Vaccine Immunol

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“…A study performed in Turkey, an intermediate TB burden country with high BCG coverage rates, showed a low specificity of the TST for the detection of latent TB infection [18]. Higuchi et al also observed a low performance of the TST in discriminating between close and casual contacts in BCG-vaccinated primary school students from Japan, a low burden country [19]. In contrast, the results from studies investigating risk factors for TST positivity in The Gambia, Brazil, and Tanzania, all high burden countries, are similar to our findings [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Influence of Bacille Calmette-Guérin on tuberculin skin testing in Venezuelan Amerindians in high tuberculosis burden areas

Maes

Verhagen

Ortega³

et al. 2014

J Infect Dev Ctries

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Introduction: Extraordinarily high tuberculosis (TB) prevalence rates have been reported in Venezuelan Amerindians. Amerindian populations often live in geographically isolated villages where they receive little medical attention and live under precarious sanitary conditions. TB prevalence varies by ethnicity and geographic location and is generally higher in Amerindians than in non-indigenous (Creole) people. Methodology: Between January 1, 1998 and December 31, 2009, the tuberculin skin test (TST) was administered during field operations to 9,538 Amerindian and Creole people between 0 and 94 years of age living in Venezuela. In 6,979 individuals (73%), Bacille CalmetteGuérin (BCG) vaccination status, age, and ethnicity were recorded.Univariate and multivariate analyses were performed to determine the influence of previous BCG vaccination, age, and ethnicity on TST outcomes. Results: Age, ethnicity, and the number of BCG vaccinations administered each had a significant influence on TST outcomes (p < 0.001). The influence of BCG vaccination on TST outcomes varied by ethnicity and was only significant in children aged between 0 and 3 years. Conclusions: The utility of TST in the diagnosis of TB infection in high TB burden settings with widespread BCG vaccination should be evaluated locally and individually as this depends on ethnicity, age, and the number of BCG vaccinations administered. In Venezuelan children 4 years of age and older, the TST remains a useful tool for the detection of TB infection, independent of BCG vaccination status.

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“…Although such studies do not directly measure LTBI, this approach is the most relevant to the important clinical question: ‘how accurately does this test identify subjects who would benefit from treatment?’ Two published studies which included child TB contacts in Japan11 and Germany12 reported variable but low positive predictive value (0% (95% CI 0 to 35), 43% (95% CI 16 to 75)) but high negative predictive value (100% (95% CI 0 to 1.5), 100% (95% CI 0 to 3)), respectively. Both studies had major limitations.…”

Section: Indications and Limitationsmentioning

confidence: 99%

How to use: interferon γ release assays for tuberculosis

Pollock

Roy

Kampmann

2013

Arch Dis Child Educ Pract Ed

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Diagnosis and treatment of latent tuberculosis infection (LTBI) is important to reduce risk of progression to active tuberculosis (TB) disease. For the past century the tuberculin skin test (TST) has been used as a measure of exposure to Mycobacterium tuberculosis (MTB), but this test has limitations in test performance, sensitivity and specificity. Interferon γ release assays (IGRA), like TST, measure host immune response to MTB. IGRA are designed to be more specific for the diagnosis of LTBI than TST in patients with previous BCG or exposure to non-tuberculous mycobacteria, detecting interferon γ generated by T cells in response to antigens more specific to MTB. Although developed as an alternative to TST, recent data, particularly in children, suggest IGRA have their own limitations. Superiority to TST as a diagnostic test in children has not been demonstrated. Neither test discriminates between current or past MTB infection, or between latent infection and active disease. This article reviews the current literature on sensitivity and specificity of IGRA in the diagnosis of LTBI, and summarises current NICE recommendations for the use of IGRA in combination with TST. Although not developed for this purpose, in clinical practice IGRA have also been used as a diagnostic test for active TB. The gold standard for diagnosis of active TB disease is microbiological confirmation by culture of MTB. This article discusses the utility of IGRA as an adjunct to diagnosis of active TB disease, but emphasises that IGRA do not have sufficient sensitivity or specificity to exclude or confirm active TB disease.

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Contact investigation in a primary school using a whole blood interferon-gamma assay

Cited by 30 publications

References 24 publications

Kinetics of a Tuberculosis-Specific Gamma Interferon Release Assay in Military Personnel with a Positive Tuberculin Skin Test

Kinetics of a Tuberculosis-Specific Gamma Interferon Release Assay in Military Personnel with a Positive Tuberculin Skin Test

Influence of Bacille Calmette-Guérin on tuberculin skin testing in Venezuelan Amerindians in high tuberculosis burden areas

How to use: interferon γ release assays for tuberculosis

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