Guidance for programmatic management of latent tuberculosis infection in the European Union/European Economic Area

Rosales-Klintz, Senia; Bruchfeld, Judith; Haas, Walter; Heldal, Einar; Houben, Rein M. G. J.; Kessel, Femke van; Mandelbaum, Mike; Matteelli, Alberto; Migliori, Giovanni Battista; Oordt-Speets, Anouk; Solovič, Ivan; Vašáková, Martina; Verver, Suzanne; Vlas, Sake J. de; Noordegraaf-Schouten, Marije J M Vonk; Vries, Gerard de; Zenner, Dominik; Werf, Marieke J. van der

doi:10.1183/13993003.02077-2018

Cited by 33 publications

(31 citation statements)

References 20 publications

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“…In settings with a low annual TB incidence (<10 cases per 100,000 population) current WHO guidelines recommend preventive therapy (PT)-which can decrease TB occurrence by 60-90% [5]-for people living with HIV, for adult contacts of TB patients, and for other clinical risk groups (e.g., homeless persons) [6]. Furthermore, depending on the migratory flows, a country may implement screening programs and LTBI PT for those who had recently arrived (e.g., asylum seekers/refugees) [7,8].…”

Section: Introductionmentioning

confidence: 99%

Latent Tuberculosis Infection Treatment Completion while Shifting Prescription from Isoniazid-Only to Rifampicin-Containing Regimens: A Two-Decade Experience in Milan, Italy

Villa

Ferrarese

Sotgiu

et al. 2019

JCM

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To tackle the tuberculosis (TB) epidemic, in 2014 the World Health Organization launched the End TB Strategy, which includes action to prevent latent TB infection (LTBI) reactivation. Available preventive treatments (PT) are based on either isoniazid (INH) alone or rifampicin (RIF)-containing regimens. This study aims to assess and compare PT completion rates, the occurrence of adverse events, and the time of dropout among those receiving INH-alone or RIF-containing regimens at Villa Marelli Institute, Milan, Italy, covering the period from 1992 to 2018. A total of 19,670 subjects, belonging to various risk groups—mainly young (median age of 29 years), foreign-born (73.3%), and males (58.8%)—with presumed LTBI were prescribed PT (79.3% INH-alone and 20.7% RIF-containing regimens). The treatment completion rate was 79.4% on average, with higher rates among those receiving RIF-containing regimens (85.6%) compared to those that were prescribed INH-alone (77.8%) (p < 0.0001). Notably, some of the high-risk groups for progression of LTBI were more likely to complete PT from RIF-containing regimens. These groups included recent TB contact (89.9%, p < 0.0001), healthcare workers (93.5%, p < 0.0001), and homeless people (76.6%, p < 0.0001). Irrespectively of the chosen PT regimen, most of the dropouts occurred between the start of the treatment and the first follow-up visit (14.3%, 15.2% for those on INH-alone vs. 11.1% for those on RIF-containing regimens). Further shortening of the PT regimen is therefore an aim to ensure adherence, even though it might need further efforts to enhance the patient’s attitude towards starting and carrying out PT.

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Section: Introductionmentioning

confidence: 99%

Latent Tuberculosis Infection Treatment Completion while Shifting Prescription from Isoniazid-Only to Rifampicin-Containing Regimens: A Two-Decade Experience in Milan, Italy

Villa

Ferrarese

Sotgiu

et al. 2019

JCM

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“…Generally infection control measures to protect HCW, including personal protective equipment and proper ventilation, undertaken in high or medium incidence countries, are not adequate, and are not a priority. Moreover, HCW were not listed as a separate risk group of infection in the recently published guidance for programmatic management of LTBI in the European Union/European Economic Area [14]. In Poland and in many Tb endemic settings, screening for LTBI among HCWs is very limited in practice and preventive treatment is almost never considered.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors for Latent Tuberculosis in Polish Healthcare Workers: The Comparison of Tuberculin Skin Test and Interferon-gamma Release Assay (IGRA) Performance.

Szturmowicz

Broniarek-Samson²,

Demkow

2021

Preprint

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Background: Tuberculosis is still one of the most common infectious diseases worldwide. Health care workers (HCW) are at particular risk of the disease due to their constant exposure to TB patients or their specimens, nevertheless no specific surveillance is widely recommended in this group of professionals. Both, tuberculin skin test (TST) and interferon-gamma-release-assays (IGRAs) are widely applied to detect latent tuberculosis infection (LTBI). The aim of the present study was to evaluate the prevalence and risks of LTBI in the population of Polish HCW, to identify factors associated with LTBI, as well as to determine the rate of the discordance between the results of the two applied tests in relation to various factors in a TB endemic setting.Material and methods: LTBI status was prospectively evaluated in 222 HCW, 204 females, 18 males, aged 40.8±9 years, with tuberculin skin test (TST) and interferon gamma release assay (QuantiFERON-TB-Gold in Tube – QFT GIT). Results: TST≥10 mm was found in 58% of HCW, QFT GIT≥0.35 IU/ml in 23%. These results are comparable with previously published data concerning general Polish population, investigated in the same period of time. Nevertheless the relative number of positive QFT GIT in HCW above 45 years of age exceeded those obtained in general population. The risk of obtaining positive QFT GIT was significantly increased in the participants older than 44 years, in those employed >10 years, and in those who reported the direct contact with tuberculous patients or infected biological materials. The concordance between TST and IGRA was poor (kappa 0.23), especially in younger participants, possibly due to BCG vaccination in childhood. Conclusion: The increased risk of LTBI in Polish HCW was related to age, duration of employment and contact with infectious patients or their biological specimens. TB infection control measures in health care facilities in Poland are still insufficient. It is crucial to increase awareness about the importance of detecting and treating LTBI of HCW.

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“…It has been estimated that one quarter of the world's population are latently infected with TB (LTBI) (Houben and Dodd, 2016), and a recent meta-analysis of prevalence surveys confirmed that 20-25% globally have LTBI (Cohen et al, 2019). This is a challenge for both high and low endemic countries, but it is evident that to reach the World Health Organization (WHO) End TB goal, the reservoir of LTBI has to be eliminated or reduced significantly (WHO, 2015;Petersen et al, 2019;Rosales-Klintz et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of IGRA/QFT-Plus for TB screening of migrants in Oman

Abri

Kowada²,

Yaqoubi

et al. 2020

International Journal of Infectious Diseases

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To estimate the cost of a screening program for identifying latent tuberculosis (TB) infections in migrants to Oman. Methods: A Markov model was used to estimate the cost of screening using an interferon-gamma release assay (IGRA) applied to all migrants from high TB endemic countries, followed by preventive TB treatment. Results: The model compared seven different scenarios, with a comparison of the direct cost and the quality-adjusted life-years (QALYs) saved. Conclusions: IGRA testing followed by 3 months of preventive treatment with rifapentine/isoniazid (3HP) was the most cost-effective intervention.

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Guidance for programmatic management of latent tuberculosis infection in the European Union/European Economic Area

Abstract: @ERSpublications Management of latent tuberculosis infection is crucial to end TB in low-incidence settings

Cited by 33 publications

References 20 publications

Latent Tuberculosis Infection Treatment Completion while Shifting Prescription from Isoniazid-Only to Rifampicin-Containing Regimens: A Two-Decade Experience in Milan, Italy

Latent Tuberculosis Infection Treatment Completion while Shifting Prescription from Isoniazid-Only to Rifampicin-Containing Regimens: A Two-Decade Experience in Milan, Italy

Prevalence and Risk Factors for Latent Tuberculosis in Polish Healthcare Workers: The Comparison of Tuberculin Skin Test and Interferon-gamma Release Assay (IGRA) Performance.

Cost-effectiveness of IGRA/QFT-Plus for TB screening of migrants in Oman

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