Tuberculin Skin Test and Boosted Reactions among Newly Employed Healthcare Workers: An Observational Study

Kim, Song Yee; Park, Moo Suk; Kim, Young Sam; Kim, Se Kyu; Chang, Joon; Yong, Dongeun; Kim, Hyun Sook; Lee, Kyungwon; Kang, Young Ae

doi:10.1371/journal.pone.0064563

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…Other studies found a similar pattern among the occupational categories [ 36 ]. The lack of significant association between being a nurse and having LTBI on multivariate analysis is similar to reports in other studies [ 37 , 38 ].…”

Section: Discussionsupporting

confidence: 90%

Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Nampula Central Hospital, Mozambique

Belo

Naidoo

2017

BMC Infect Dis

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BackgroundHealthcare workers in high tuberculosis burdened countries are occupationally exposed to the tuberculosis disease with uncomplicated and complicated tuberculosis on the increase among them. Most of them acquire Mycobacterium tuberculosis but do not progress to the active disease – latent tuberculosis infection. The objective of this study was to assess the prevalence and risk factors associated with latent tuberculosis infection among healthcare workers in Nampula Central Hospital, Mozambique.MethodsThis cross-sectional study of healthcare workers was conducted between 2014 and 2015. Participants (n = 209) were administered a questionnaire on demographics and occupational tuberculosis exposure and had a tuberculin skin test administered. Multivariate linear and logistic regression tested for associations between independent variables and dependent outcomes (tuberculin skin test induration and latent tuberculosis infection status).ResultsThe prevalence of latent tuberculosis infection was 34.4%. Latent tuberculosis infection was highest in those working for more than eight years (39.3%), those who had no BCG vaccination (39.6%) and were immunocompromised (78.1%). Being immunocompromised was significantly associated with latent tuberculosis infection (OR 5.97 [95% CI 1.89; 18.87]). Positive but non-significant associations occurred with working in the medical domain (OR 1.02 [95% CI 0.17; 6.37]), length of employment > eight years (OR 1.97 [95% CI 0.70; 5.53]) and occupational contact with tuberculosis patients (OR 1.24 [95% CI 0.47; 3.27]).ConclusionsPersonal and occupational factors were positively associated with latent tuberculosis infection among healthcare workers in Mozambique.

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Section: Discussionsupporting

confidence: 90%

Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Nampula Central Hospital, Mozambique

Belo

Naidoo

2017

BMC Infect Dis

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“…We do not have results from the baseline two-step TST; thus, it is difficult to know whether the positive result from the secondary TST is boosted by the two-step TST or is newly triggered after exposure. However, the two-step TST is not mandatory at the time of TB exposure investigation for the purpose of detection and treatment of latent TB 17. Lastly, we restricted the LTBI test subjects to only close contact HCWs and immunocompromised patients with limited follow-up visits among close contact patients or visitors in approximately 20% (65/322), despite active contact by ICPs.…”

Section: Discussionmentioning

confidence: 99%

Aggressive Contact Investigation of In-Hospital Exposure to Active Pulmonary Tuberculosis

et al. 2019

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Background In-hospital detection of newly diagnosed active pulmonary tuberculosis (TB) is important for prevention of potential outbreaks. Here, we report our experience of the aggressive contact investigation strategy in a university hospital in the Republic of Korea after healthcare workers (HCWs), patients, and visitors experience an in-hospital exposure to active pulmonary TB. Methods A contact investigation after the unexpected detection of newly diagnosed active pulmonary TB (index patients) was performed in a university hospital from August 2016 to April 2017. Initial and 3-month-post-exposure chest radiographs were advised for all patients, visitors, and HCWs in close contact with the index patients. An additional tuberculous skin test or interferon gamma releasing assay was performed at the time of exposure and 3 months post-exposure in HCWs in close contact with the index patients. Results Twenty-four index patients were unexpectedly diagnosed with active pulmonary TB after admission to the hospital with unassociated diseases. The median time from admission to TB diagnosis was 5 days (range, 1–22 days). In total, 1,057 people were investigated because of contact with the index patients, 528 of which had close contact (206 events in 157 HCWs, 322 patients or visitors). Three months post exposure, 9 (9.2%) among 98 TB-naïve close contact HCWs developed latent tuberculosis infections (LTBIs). Among the 65 close contact patients or visitors, there was no radiological or clinical evidence of active pulmonary TB. Conclusion An aggressive contact investigation after an unexpected in-hospital diagnosis of active pulmonary TB revealed a high incidence of LTBI among TB-naïve HCWs who had contact with the index patients.

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“…If TST is performed for baseline screening, a two-step TST test (retest 1–4 weeks later in cases where the initial TST result is negative) is required to counter the booster effect. In a previous study, the booster effect was observed in 14.2% of South Korean HCWs 12 . A second TST is not required if the HCW has a documented TST result from any time during the previous 12 months.…”

Section: Baseline Screening For Ltbi In Newly Hired Hcwsmentioning

confidence: 83%

Diagnosis and Treatment of Latent Tuberculosis Infection in Healthcare Workers

Mok

2016

Tuberc Respir Dis

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Tuberculosis (TB) is one of the most important occupational risks for healthcare workers (HCWs) in South Korea. Many policies regarding the control and prevention of TB in healthcare settings recommend that HCWs are tested for latent tuberculosis infection (LTBI) in addition to active TB. Moreover, the Korean Tuberculosis Prevention Act also recommends that HCWs receive regular testing for LTBI. However, there are no specific or detailed guidelines for dealing with LTBI in HCWs. Herein, we discuss the diagnosis and treatment of LTBI in HCWs and focus particularly on the baseline screening of hired HCWs, routine follow-up, and contact investigation.

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Tuberculin Skin Test and Boosted Reactions among Newly Employed Healthcare Workers: An Observational Study

Cited by 10 publications

References 21 publications

Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Nampula Central Hospital, Mozambique

Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Nampula Central Hospital, Mozambique

Aggressive Contact Investigation of In-Hospital Exposure to Active Pulmonary Tuberculosis

Diagnosis and Treatment of Latent Tuberculosis Infection in Healthcare Workers

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