Prevalence and risk factors for latent tuberculosis in polish healthcare workers: the comparison of tuberculin skin test and interferon-gamma release assay (IGRA) performance.

Abstract

Background: Tuberculosis (TB) is still one of the most common infectious diseases worldwide. Health care workers (HCW) are at particular risk of the disease due to their constant exposure to TB patients or their specimens, nevertheless no specific surveillance is widely recommended in this group of professionals. Both, tuberculin skin test (TST) and interferon-gamma-release-assays (IGRAs) are widely applied to detect latent tuberculosis infection (LTBI). The aim of the present study was to evaluate the prevalence and risks of LTBI in the population of Polish HCW, to identify factors associated with LTBI, as well as to determine the rate of the discordance between the results of the two applied tests in relation to various factors in a TB endemic setting. The study participants were recruited from several health care facilities (hospitals and outpatients clinics) all over the country. Laboratory personnel included 156 persons from both TB and non-TB laboratories (118 clinical pathologists, 38 laboratory technicians), 31 medical doctors, 29 nurses (from both TB and non-TB wards and from family practices), 6 other medical employees (patients assistants). Out of examined group 88 (40%) declared constant (everyday) occupational contact with TB patients and/or contagious biologic materials, 134 (60%) reported sporadic (incidental) contact (few times a year). Administrative HCWs who were not in direct contact with patients were not included in the study group.

Material and methods: LTBI status was prospectively evaluated in 222 HCW, 204 females, 18 males, aged 40.8 ± 9 years, with tuberculin skin test (TST) and interferon gamma release assay (QuantiFERON-TB-Gold in Tube - QFT GIT).

Results: TST ≥ 10 mm was found in 58% of HCW, QFT GIT ≥ 0.35 IU/ml in 23%. Nevertheless the relative number of positive QFT GIT in HCW above 45 years of age exceeded those obtained in general population (prevalence of positive QTF test in polish adult population is around 23%). The risk of obtaining positive QFT GIT was significantly increased in the participants older than 44 years (OR = 4.95, 95%CI:2.375-10.193), in those employed > 10 years (OR = 2.726, 95%CI:1.126-6.599), and in those who reported the direct contact with tuberculous patients or infected biological materials (OR = 8.135, 95%CI:1.297-51.016). The concordance between TST and IGRA was poor (kappa 0.23), especially in younger participants, possibly due to BCG vaccination in childhood.

Conclusion: The increased risk of LTBI in Polish HCW was related to age, duration of employment and contact with infectious patients or their biological specimens. TB infection control measures in health care facilities in Poland are still insufficient. It is crucial to increase awareness about the importance of detecting and treating LTBI of HCW.