Use of T Cell–Based Diagnosis of Tuberculosis Infection to Optimize Interpretation of Tuberculin Skin Testing for Child Tuberculosis Contacts

Bakır, Mustafa; Dosanjh, Davinder; Deeks, Jonathan J; Soysal, Ahmet; Millington, Kerry; Efe, Serpil; Aslan, Yasemin; Polat, Dilek; Kodallı, Nihat; Yağcı, Ayşegül; Barlan, Işıl; Bahceciler, Nerin N.; Demiralp, Emel; Lalvani, Ajit

doi:10.1086/595847

Cited by 25 publications

(25 citation statements)

References 43 publications

(61 reference statements)

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“…This finding confirmed results of a previous study [23]. This finding may also explain that the sensitivity of the tuberculin skin test as measured against gamma interferon release assay results as reference standard is lower in BCG immunized individuals due to a higher false negative tuberculin skin test rate [24,25].…”

Section: Evidence Against the Hypothesissupporting

confidence: 90%

Reduction of Mycobacterium tuberculosis infection in Bacillus Calmette Guerin immunized people is due to training of innate immunity

Eisenhut

2015

Medical Hypotheses

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Section: Evidence Against the Hypothesissupporting

confidence: 90%

Reduction of Mycobacterium tuberculosis infection in Bacillus Calmette Guerin immunized people is due to training of innate immunity

Eisenhut

2015

Medical Hypotheses

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“…Furthermore, although NICE's recommendation for the two-step method of screening (ie, tuberculin skin-test plus confirmatory IGRA) has been adopted in most European countries, the USA, 14 and many centres in the UK increasingly use one-step IGRA testing to screen for latent infection, 13,15 probably because of this test's high specificity 16–18 . Additional reasons for the use of the one-step test include evidence that IGRAs might be able to predict the development of active tuberculosis from latent infection, 19–28 and uncertainty about the optimum cutoff for a positive skin test in the context of previous BCG vaccination 29 . We did this multicentre cohort study to compute yields from, and cost-effectiveness of, screening for latent infection at different thresholds in relation to incidence of tuberculosis in immigrants' countries of origin.…”

Section: Introductionmentioning

confidence: 99%

Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis

Pareek

Watson

Ormerod

et al. 2011

The Lancet Infectious Diseases

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178

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SummaryBackgroundContinuing rises in tuberculosis notifications in the UK are attributable to cases in foreign-born immigrants. National guidance for immigrant screening is hampered by a lack of data about the prevalence of, and risk factors for, latent tuberculosis infection in immigrants. We aimed to determine the prevalence of latent infection in immigrants to the UK to define which groups should be screened and to quantify cost-effectiveness.MethodsIn our multicentre cohort study and cost-effectiveness analysis we analysed demographic and test results from three centres in the UK (from 2008 to 2010) that used interferon-γ release-assay (IGRA) to screen immigrants aged 35 years or younger for latent tuberculosis infection. We assessed factors associated with latent infection by use of logistic regression and calculated the yields and cost-effectiveness of screening at different levels of tuberculosis incidence in immigrants' countries of origin with a decision analysis model.FindingsResults for IGRA-based screening were positive in 245 of 1229 immigrants (20%), negative in 982 (80%), and indeterminate in two (0·2%). Positive results were independently associated with increases in tuberculosis incidence in immigrants' countries of origin (p=0·0006), male sex (p=0·046), and age (p<0·0001). National policy thus far would fail to detect 71% of individuals with latent infection. The two most cost-effective strategies were to screen individuals from countries with a tuberculosis incidence of more than 250 cases per 100 000 (incremental cost-effectiveness ratio [ICER] was £17 956 [£1=US$1·60] per prevented case of tuberculosis) and at more than 150 cases per 100 000 (including immigrants from the Indian subcontinent), which identified 92% of infected immigrants and prevented an additional 29 cases at an ICER of £20 819 per additional case averted.InterpretationScreening for latent infection can be implemented cost-effectively at a level of incidence that identifies most immigrants with latent tuberculosis, thereby preventing substantial numbers of future cases of active tuberculosis.FundingMedical Research Council and Wellcome Trust.

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“…In the UK this is 15 mm and in the United States and Spain 10 mm [1]. The high risk posed by M. tuberculosis for children less than two years of age, with a risk of progression to disseminated tuberculosis and meningitis from 10 to 20% and tuberculosis in general of 50%, makes it essential to diagnose latent M. tuberculosis infection with maximum sensitivity.…”

Section: Introductionmentioning

confidence: 99%

Performance of Tuberculin Skin Test Measured against Interferon Gamma Release Assay as Reference Standard in Children

Eisenhut

Fidler

2014

Tuberculosis Research and Treatment

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Objectives. International guidelines differ in the threshold of tuberculin skin test (TST) induration regarded as indicating Mycobacterium (M.) tuberculosis infection. Interferon gamma release assay (IGRA) results were used as reference to assess performance of TST induration thresholds for detection of M. tuberculosis infection in children. Design. Systematic review which included studies containing data on TST, IGRA, and Bacillus Calmette-Guérin (BCG) status in children. Data bases searched were PubMed, EMBASE, and the Cochrane library. Specificities and sensitivities were calculated for TST thresholds 5, 10, and 15 mm and correlated with age and geographical latitude. Results. Eleven studies with 2796 children were included. For BCG immunised children diameters of 5, 10, and 15 mm had median sensitivities of 87, 70, and 75% and specificities of 67, 93, and 90%, respectively. In non-BCG immunised children median sensitivities were 94, 95, and 83% and specificities 91, 95, and 97%. At the 10 mm threshold age correlated negatively with sensitivity of TST (r = −0.65, P = 0.04) and latitude correlated positively (r = 0.71, P = 0.02). Conclusions. For the 10 mm threshold the sensitivity of the TST is lower in BCG immunised children. Younger age and higher geographical latitude were associated with higher sensitivity of the TST.

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Use of T Cell–Based Diagnosis of Tuberculosis Infection to Optimize Interpretation of Tuberculin Skin Testing for Child Tuberculosis Contacts

Cited by 25 publications

References 43 publications

Reduction of Mycobacterium tuberculosis infection in Bacillus Calmette Guerin immunized people is due to training of innate immunity

Reduction of Mycobacterium tuberculosis infection in Bacillus Calmette Guerin immunized people is due to training of innate immunity

Screening of immigrants in the UK for imported latent tuberculosis: a multicentre cohort study and cost-effectiveness analysis

Performance of Tuberculin Skin Test Measured against Interferon Gamma Release Assay as Reference Standard in Children

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