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Free Content Value of adding an IGRA to the TST to screen for latent tuberculous infection in Greek health care workers

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SETTING: Ioannina University Hospital, Ioannina, Greece.

OBJECTIVE: To evaluate the value of adding an interferon-gamma release assay (IGRA) to the tuberculin skin test (TST) for detecting latent tuberculous infection (LTBI) in a Greek university hospital among health care workers (HCWs) predominantly vaccinated with bacille Calmette-Guérin (BCG).

DESIGN: Of 788 HCWs enrolled, 68.1% were BCG-vaccinated. A TST  10 mm was considered positive and was followed by the QuantiFERON-TB® Gold In-Tube assay (QFT-GIT) in a two-step strategy.

RESULTS: Of the enrolled HCWs, 36.4% were TST-positive, of whom only 14.4% were IGRA-positive. Agreement between the tests was poor (κ = 0.019; 95%CI −0.014–0.05, P = 0.355). Both TST and IGRA positivity increased with TST diameter, from 5.7% in TST 10–14 mm to 48.8% in TST 20 mm. TST-positive, IGRA-negative results were most likely in younger, recently BCG-vaccinated HCWs (84.6% in those aged 20–29 years) and less likely in older HCWs (45% in those aged 50–59 years). The two-step strategy would have been more cost saving compared to the TST-only approach if adherence to LTBI treatment in our cohort had been 24%.

CONCLUSIONS: Poor overall agreement between TST and QFT-GIT was found. Use of IGRA as a second step in TST-positive cases offers an appropriate tool for LTBI detection among BCG-vaccinated HCWs in low-TB-incidence settings.
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Keywords: BCG; hospital employees; occupational TB; testing; treatment

Document Type: Research Article

Affiliations: 1: Departments of Pulmonary Medicine 2: Family Medicine 3: Microbiology, University Hospital of Ioannina, Ioannina, Greece

Publication date: September 1, 2014

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

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    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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