IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0043014.html
   My bibliography  Save this article

TB Screening in Canadian Health Care Workers Using Interferon-Gamma Release Assays

Author

Listed:
  • Alice Zwerling
  • Mihaela Cojocariu
  • Fiona McIntosh
  • Filomena Pietrangelo
  • Marcel A Behr
  • Kevin Schwartzman
  • Andrea Benedetti
  • Nandini Dendukuri
  • Dick Menzies
  • Madhukar Pai

Abstract

Background: While many North American healthcare institutions are switching from Tuberculin Skin Test (TST) to Interferon-gamma release assays (IGRAs), there is relatively limited data on association between occupational tuberculosis (TB) risk factors and test positivity and/or patterns of test discordance. Methods: We recruited a cohort of Canadian health care workers (HCWs) in Montreal, and performed both TST and QuantiFERON-TB Gold In Tube (QFT) tests, and assessed risk factors and occupational exposure. Results: In a cross-sectional analysis of baseline results, the prevalence of TST positivity using the 10 mm cut-off was 5.7% (22/388, 95%CI: 3.6–8.5%), while QFT positivity was 6.2% (24/388, 95%CI: 4–9.1%). Overall agreement between the tests was poor (kappa = 0.26), and 8.3% of HCWs had discordant test results, most frequently TST−/QFT+ (17/388, 4.4%). TST positivity was associated with total years worked in health care, non-occupational exposure to TB and BCG vaccination received after infancy or on multiple occasions. QFT positivity was associated with having worked as a HCW in a foreign country. Conclusions: Our results suggest that LTBI prevalence as measured by either the TST or the QFT is low in this HCW population. Of concern is the high frequency of unexplainable test discordance, namely: TST−/QFT+ subjects, and the lack of any association between QFT positivity and clear-cut recent TB exposure. If these discordant results are indeed false positives, the use of QFT in lieu of TST in low TB incidence settings could result in overtreatment of uninfected individuals.

Suggested Citation

  • Alice Zwerling & Mihaela Cojocariu & Fiona McIntosh & Filomena Pietrangelo & Marcel A Behr & Kevin Schwartzman & Andrea Benedetti & Nandini Dendukuri & Dick Menzies & Madhukar Pai, 2012. "TB Screening in Canadian Health Care Workers Using Interferon-Gamma Release Assays," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-9, August.
    • Handle: RePEc:plo:pone00:0043014
    DOI: 10.1371/journal.pone.0043014
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0043014
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0043014&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0043014?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Anandharaman Veerapathran & Rajnish Joshi & Kalyan Goswami & Sandeep Dogra & Erica E M Moodie & M V R Reddy & Shriprakash Kalantri & Kevin Schwartzman & Marcel A Behr & Dick Menzies & Madhukar Pai, 2008. "T-Cell Assays for Tuberculosis Infection: Deriving Cut-Offs for Conversions Using Reproducibility Data," PLOS ONE, Public Library of Science, vol. 3(3), pages 1-7, March.
    2. Richard N van Zyl-Smit & Alice Zwerling & Keertan Dheda & Madhukar Pai, 2009. "Within-Subject Variability of Interferon-g Assay Results for Tuberculosis and Boosting Effect of Tuberculin Skin Testing: A Systematic Review," PLOS ONE, Public Library of Science, vol. 4(12), pages 1-8, December.
    3. Rajnish Joshi & Arthur L Reingold & Dick Menzies & Madhukar Pai, 2006. "Tuberculosis among Health-Care Workers in Low- and Middle-Income Countries: A Systematic Review," PLOS Medicine, Public Library of Science, vol. 3(12), pages 1-16, December.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ioana Nicolau & Daphne Ling & Lulu Tian & Christian Lienhardt & Madhukar Pai, 2012. "Research Questions and Priorities for Tuberculosis: A Survey of Published Systematic Reviews and Meta-Analyses," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-1, July.
    2. Halim Ismail & Naiemy Reffin & Sharifa Ezat Wan Puteh & Mohd Rohaizat Hassan, 2021. "Compliance of Healthcare Worker’s toward Tuberculosis Preventive Measures in Workplace: A Systematic Literature Review," IJERPH, MDPI, vol. 18(20), pages 1-21, October.
    3. Sommerland, Nina & Masquillier, Caroline & Rau, Asta & Engelbrecht, Michelle & Kigozi, Gladys & Pliakas, Triantafyllos & Janse van Rensburg, Andre & Wouters, Edwin, 2020. "Reducing HIV- and TB-Stigma among healthcare co-workers in South Africa: Results of a cluster randomised trial," Social Science & Medicine, Elsevier, vol. 266(C).
    4. Bingke Zhu & Hao Fan & Bingbing Xie & Ran Su & Chaofeng Zhou & Jianping He, 2020. "Mapping the Scientific Research on Healthcare Workers’ Occupational Health: A Bibliometric and Social Network Analysis," IJERPH, MDPI, vol. 17(8), pages 1-22, April.
    5. Anna Rita Corvino & Maria Grazia Lourdes Monaco & Elpidio Maria Garzillo & Elena Grimaldi & Giovanna Donnarumma & Nadia Miraglia & Gabriella Di Giuseppe & Monica Lamberti, 2020. "Tuberculosis Infection Screening in 5468 Italian Healthcare Students: Investigation of a Borderline Zone Value for the QFT-Test," IJERPH, MDPI, vol. 17(18), pages 1-9, September.
    6. Tolu Oni & Hannah P Gideon & Nonzwakazi Bangani & Relebohile Tsekela & Ronnett Seldon & Kathryn Wood & Katalin A Wilkinson & Rene T Goliath & Tom H M Ottenhoff & Robert J Wilkinson, 2012. "Smoking, BCG and Employment and the Risk of Tuberculosis Infection in HIV-Infected Persons in South Africa," PLOS ONE, Public Library of Science, vol. 7(10), pages 1-5, October.
    7. Xia Zhang & Hongyan Jia & Fei Liu & Liping Pan & Aiying Xing & Shuxiang Gu & Boping Du & Qi Sun & Rongrong Wei & Zongde Zhang, 2013. "Prevalence and Risk Factors for Latent Tuberculosis Infection among Health Care Workers in China: A Cross-Sectional Study," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-6, June.
    8. Rajni Rai & Sonia El-Zaemey & Nidup Dorji & Bir Doj Rai & Lin Fritschi, 2021. "Exposure to Occupational Hazards among Health Care Workers in Low- and Middle-Income Countries: A Scoping Review," IJERPH, MDPI, vol. 18(5), pages 1-41, March.
    9. Jennifer A. Whitaker & Veriko Mirtskhulava & Maia Kipiani & Drew A Harris & Nino Tabagari & Russell R Kempker & Henry M Blumberg, 2013. "Prevalence and Incidence of Latent Tuberculosis Infection in Georgian Healthcare Workers," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-8, March.
    10. Jennica Garnett & David Jones & Graham Chin & Jerry M. Spiegel & Annalee Yassi & Nisha Naicker, 2020. "Occupational Tuberculosis Among Laboratory Workers in South Africa: Applying a Surveillance System to Strengthen Prevention and Control," IJERPH, MDPI, vol. 17(5), pages 1-12, February.
    11. Dikeledi O. Matuka & Thabang Duba & Zethembiso Ngcobo & Felix Made & Lufuno Muleba & Tebogo Nthoke & Tanusha S. Singh, 2021. "Occupational Risk of Airborne Mycobacterium tuberculosis Exposure: A Situational Analysis in a Three-Tier Public Healthcare System in South Africa," IJERPH, MDPI, vol. 18(19), pages 1-15, September.
    12. Thanthun Sangphoo & Naesinee Chaiear & Patimaporn Chanpho, 2020. "Work-Related Tuberculosis among Health Workers Employed in a Tertiary Hospital in Northeastern Thailand: A Report of Nine Cases," IJERPH, MDPI, vol. 17(14), pages 1-8, July.
    13. Sahal Al Hajoj & Bright Varghese & Alria Datijan & Mohammed Shoukri & Ali Alzahrani & Abdallah Alkhenizan & Abdulaziz AlSaif & Sahar Althawadi & Grace Fernandez & Abdulrahman Alrajhi, 2016. "Interferon Gamma Release Assay versus Tuberculin Skin Testing among Healthcare Workers of Highly Diverse Origin in a Moderate Tuberculosis Burden Country," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-11, May.
    14. Rajnish Joshi & Samir Patil & Shriprakash Kalantri & Kevin Schwartzman & Dick Menzies & Madhukar Pai, 2007. "Prevalence of Abnormal Radiological Findings in Health Care Workers with Latent Tuberculosis Infection and Correlations with T Cell Immune Response," PLOS ONE, Public Library of Science, vol. 2(8), pages 1-9, August.
    15. Bin Chen & Xiaomeng Wang & Jiemin Zhong & Songhua Chen & Beibei Wu & Hui-Chi Yeh & Zhenggang Jiang & Zhengting Wang & Hua Gu & Jianmin Jiang, 2014. "Tuberculosis among Healthcare Workers in Southeastern China: A Retrospective Study of 7-Year Surveillance Data," IJERPH, MDPI, vol. 11(11), pages 1-11, November.
    16. Esther Vaquero-Álvarez & Antonio Cubero-Atienza & Pilar Ruiz-Martínez & Manuel Vaquero-Abellán & María Dolores Redel-Macías & Pilar Aparicio-Martínez, 2020. "Tuberculosis and Other Airborne Microbes in Occupational Health and Safety," IJERPH, MDPI, vol. 17(19), pages 1-16, September.
    17. Mohammad Hossein YektaKooshali & Farahnaz Movahedzadeh & Ali Alavi Foumani & Hoda Sabati & Alireza Jafari, 2019. "Is latent tuberculosis infection challenging in Iranian health care workers? A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-19, October.
    18. Nathan N O’Hara & Lilla Roy & Lyndsay M O’Hara & Jerry M Spiegel & Larry D Lynd & J Mark FitzGerald & Annalee Yassi & Letshego E Nophale & Carlo A Marra, 2015. "Healthcare Worker Preferences for Active Tuberculosis Case Finding Programs in South Africa: A Best-Worst Scaling Choice Experiment," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-13, July.
    19. Patimaporn Chanpho & Naesinee Chaiear & Supot Kamsa-ard, 2020. "Factors Associated with Latent Tuberculosis Infection among the Hospital Employees in a Tertiary Hospital of Northeastern Thailand," IJERPH, MDPI, vol. 17(18), pages 1-12, September.
    20. Mohajan, Haradhan, 2014. "Tuberculosis is a Fatal Disease among Some Developing Countries of the World," MPRA Paper 82851, University Library of Munich, Germany, revised 22 Jan 2015.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0043014. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.