Tuberculosis Screening, Testing, and Treatment of US Health Care Personnel

Thanassi, Wendy; Behrman, Amy; Reves, Randall; Russi, Mark; Swift, Melanie D.; Warkentin, Jon; Miyakawa, Ryo; Wegener, Donna Hope; Budnick, Lawrence D.; Murray, Ellen; Scarpita, Ann; Hurst, Bobbi Jo; Foster-Chang, Sarah; Mathew, Trini; Gruden, MaryAnn; Higashi, Julie; Hudson, T

doi:10.1097/jom.0000000000001904

Cited by 4 publications

(2 citation statements)

References 71 publications

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“…The work presented here has potential impact beyond the current pandemic. Occupational testing has previously been recommended in healthcare workers for other illnesses including Tuberculosis and Hepatitis B [54][55][56] . However, these tests are typically run a maximum of once to twice a year per worker.…”

Section: Discussionmentioning

confidence: 99%

Singleplex, multiplex and pooled sample real-time RT-PCR assays for detection of SARS-CoV-2 in an occupational medicine setting

Butler

Carson²,

Podlevsky³

et al. 2022

Sci Rep

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For workplaces which cannot operate as telework or remotely, there is a critical need for routine occupational SARS-CoV-2 diagnostic testing. Although diagnostic tests including the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel (CDC Diagnostic Panel) (EUA200001) were made available early in the pandemic, resource scarcity and high demand for reagents and equipment necessitated priority of symptomatic patients. There is a clearly defined need for flexible testing methodologies and strategies with rapid turnaround of results for (1) symptomatic, (2) asymptomatic with high-risk exposures and (3) asymptomatic populations without preexisting conditions for routine screening to address the needs of an on-site work force. We developed a distinct SARS-CoV-2 diagnostic assay based on the original CDC Diagnostic Panel (EUA200001), yet, with minimum overlap for currently employed reagents to eliminate direct competition for limited resources. As the pandemic progressed with testing loads increasing, we modified the assay to include 5-sample pooling and amplicon target multiplexing. Analytical sensitivity of the pooled and multiplexed assays was rigorously tested with contrived positive samples in realistic patient backgrounds. Assay performance was determined with clinical samples previously assessed with an FDA authorized assay. Throughout the pandemic we successfully tested symptomatic, known contact and travelers within our occupational population with a ~ 24–48-h turnaround time to limit the spread of COVID-19 in the workplace. Our singleplex assay had a detection limit of 31.25 copies per reaction. The three-color multiplexed assay maintained similar sensitivity to the singleplex assay, while tripling the throughput. The pooling assay further increased the throughput to five-fold the singleplex assay, albeit with a subtle loss of sensitivity. We subsequently developed a hybrid ‘multiplex-pooled’ strategy to testing to address the need for both rapid analysis of samples from personnel at high risk of COVID infection and routine screening. Herein, our SARS-CoV-2 assays specifically address the needs of occupational healthcare for both rapid analysis of personnel at high-risk of infection and routine screening that is essential for controlling COVID-19 disease transmission. In addition to SARS-CoV-2 and COVID-19, this work demonstrates successful flexible assays developments and deployments with implications for emerging highly transmissible diseases and future pandemics.

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Section: Discussionmentioning

confidence: 99%

Singleplex, multiplex and pooled sample real-time RT-PCR assays for detection of SARS-CoV-2 in an occupational medicine setting

Butler

Carson²,

Podlevsky³

et al. 2022

Sci Rep

View full text Add to dashboard Cite

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“…Laborarbeiten, wie das Verarbeiten von Patientenproben oder das Handling von Kulturen mit Tuberkulosebakterien, werden als erhöhtes Infektionsrisiko für das Personal eingeschätzt 91 . Es sind hier v. a. die aerosolerzeugenden Prozesse, wie das Öffnen und Entleeren von Probengefäßen, das Mischen, Pipettieren oder Verimpfen von Patientenproben, aber auch unbeabsichtigte Kontaminationen (zerbrochene Gefäße, verschüttetes Material), die eine Infektionsgefahr für das Personal darstellen.…”

Section: Maßnahmen In Speziellen Situationen Und Bereichenunclassified

Infektionsprävention & Hygiene bei Tuberkulose – Empfehlungen des DZK

Witte,

Arvand,

Barth

et al. 2023

Pneumologie

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ZusammenfassungDie Vermeidung der Weiterverbreitung der Erkrankung ist ein wesentliches Ziel in der Betreuung und Behandlung von Tuberkulose. Für die Infektionsprävention von besonderer Bedeutung sind neben der frühzeitigen Diagnose und effektiven Therapien eine Isolierung ansteckungsfähiger Patientinnen und Patienten und adäquate Hygienemaßnahmen. Die vorliegenden Empfehlungen ersetzen die bisherigen Empfehlungen „Infektionsprävention bei Tuberkulose“ aus dem Jahre 2012 und berücksichtigen die aktuellen nationalen und internationalen Empfehlungen und neue wissenschaftlichen Erkenntnisse. Nach einer Beschreibung der Infektion und der Übertragungswege werden die notwendigen Präventions- und Hygienemaßnahmen in Gesundheitseinrichtungen umfangreich dargestellt. Seit der letzten Überarbeitung der Empfehlungen zur Infektionsprävention wurden internationale Empfehlungen und die KRINKO-Empfehlung zur Beendigung der Isolierung geändert. In Übereinstimmung hiermit kann unter bestimmten Voraussetzungen bei sensibler Tuberkulose eine Entisolierung in Gesundheitseinrichtungen nach 14 Tagen ohne Berücksichtigung der Sputumbefunde erfolgen. Im zweiten Teil der Empfehlungen werden ausführlich die Maßnahmen in speziellen Situationen und Bereichen, wie Arztpraxen, Krankentransport und Pflegeeinrichtungen, erläutert. Hier wurden die Empfehlungen zum Atemschutz vereinfacht, für Personal wird eine FFP2-Maske nun generell als ausreichend erachtet.

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A Case of Multidrug-Resistant Tuberculosis in an Active Duty Military Health Care Worker

Saunders,

Shanahan,

Downs

2024

Military Medicine

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Cases of active tuberculosis (TB) in the U.S. Military have fallen over the last century in large part due to improved screening and treatment options. The subset of multidrug-resistant TB (MDR-TB) is almost nonexistent within the U.S. Military. We present a case of MDR-TB in an active duty U.S. Military health care worker and discuss several considerations for treatment that may present challenges for U.S. Military medical practitioners. A 30-year-old active duty Soldier was referred to Army public health services after a bronchoscopy sample was positive for Mycobacterium tuberculosis complex. Sputum smears were negative for acid-fast bacilli, suggesting lower risk for community spread. One month after initiation of the standard 4-drug regimen for active TB, genetic susceptibility testing found the patient’s M. tuberculosis isolate to be resistant to rifampin, isoniazid, and pyrazinamide. Contact investigation efforts among co-workers and family members fortunately found no new interferon-gamma release assay conversions. Coordination of public health assets to ensure a successful treatment regimen occurred across varied local, state, and federal agencies. Atypical medications required coordination with the FDA for procurement. An extensive surveillance plan for medication adverse effects was required. Finally, questions of public health authority versus patient autonomy arose requiring multidisciplinary input and ethical discussions.

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Tuberculosis Screening, Testing, and Treatment of US Health Care Personnel

Cited by 4 publications

References 71 publications

Singleplex, multiplex and pooled sample real-time RT-PCR assays for detection of SARS-CoV-2 in an occupational medicine setting

Singleplex, multiplex and pooled sample real-time RT-PCR assays for detection of SARS-CoV-2 in an occupational medicine setting

Infektionsprävention & Hygiene bei Tuberkulose – Empfehlungen des DZK

A Case of Multidrug-Resistant Tuberculosis in an Active Duty Military Health Care Worker

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