Tuberculosis infection risk, preventive therapy care cascade and incidence of tuberculosis disease in healthcare workers at Maputo Central Hospital

被引：6

作者：

Graves, Susannah K. ^{[1
]}

Augusto, Orvalho ^{[2
]}

Viegas, Sofia Omar ^{[3
]}

Lederer, Philip ^{[4
]}

David, Catarina ^{[5
]}

Lee, Kristen ^{[4
]}

Hassane, Anila ^{[5
]}

Cossa, Anilsa ^{[5
]}

Amade, Salma ^{[5
]}

Peleve, Susete ^{[5
]}

Zindoga, Pereira ^{[5
]}

Massawo, Leguesse ^{[3
]}

Torriani, Francesca J. ^{[1
,6
,7
]}

Nunes, Elizabete A. ^{[5
]}

机构：

[1] Univ Calif San Diego, Dept Internal Med, Div Infect Dis, 9500 Gilman Dr MC 0711, La Jolla, CA 92093 USA

[2] Univ Eduardo Mondlane, Fac Med, Maputo, Mozambique

[3] Inst Nacl Saude, Minist Saude, Maputo, Mozambique

[4] Boston Univ, Sch Med, Dept Med, Boston, MA 02118 USA

[5] Maputo Cent Hosp, Dept Internal Med, Av Agostinho Neto 364, Maputo, Mozambique

[6] UC San Diego Hlth, UC San Diego Infect Prevent & Clin Epidemiol Unit, 200 W Arbor Dr,MC 8951, San Diego, CA 92103 USA

[7] UC San Diego Hlth, TB Control Unit, 200 W Arbor Dr,MC 8951, San Diego, CA 92103 USA

来源：

BMC INFECTIOUS DISEASES | 2019年 / 19卷 / 1期

关键词：

Tuberculosis; Latent tuberculosis infection; Interferon-gamma release assay; Healthcare workers; HIV; Isoniazid preventive therapy; LATENT TUBERCULOSIS; RIFAMPIN; TRANSMISSION; PREVALENCE; COUNTRIES;

D O I：

10.1186/s12879-019-3966-7

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

BackgroundMozambican healthcare workers have high rates of latent and active tuberculosis, but occupational screening for tuberculosis is not routine in this setting. Furthermore, the specificity of tuberculin skin testing in this population compared with interferon gamma release assay testing has not been established.MethodsThis study was conducted among healthcare workers at Maputo Central Hospital, a public teaching quaternary care hospital in Mozambique. With a cross sectional study design, risk factors for tuberculosis were assessed using multivariable logistic regression. The care cascade is reported for participants who were prescribed six months of isoniazid preventive therapy for HIV or highly reactive testing for latent tuberculosis infection. The agreement of interferon-gamma release assay results with positive tuberculin skin testing was calculated.ResultsOf 690 screened healthcare workers, three (0.4%) had active tuberculosis and 426 (61.7%) had latent tuberculosis infection. Less education, age 35-49, longer hospital service, and work in the surgery department were associated with increased likelihood of being tuberculosis infected at baseline (p<0.05). Sex, Bacillus Calmette-Guerin vaccination, HIV, outside tuberculosis contacts, and professional category were not. Three new cases of active tuberculosis developed during the follow-up period, two while on preventive therapy. Among 333 participants offered isoniazid preventive therapy, five stopped due to gastrointestinal side effects and 181 completed treatment. For HIV seropositive individuals, the agreement of interferon gamma release assay positivity with positive tuberculin skin testing was 50% among those with a quantitative skin test result of 5-10mm, and among those with a skin test result 10mm it was 87.5%. For HIV seronegative individuals, the agreement of interferon gamma release assay positivity with a tuberculin skin test result of 10-14mm was 63.6%, and for those with a quantitative skin test result 15mm it was 82.2%.ConclusionsThere is a high prevalence of tuberculosis infected healthcare workers at Maputo Central Hospital. The surgery department was most heavily affected, suggesting occupational risk. Isoniazid preventive therapy initiation was high and just over half completed therapy. An interferon gamma release assay was useful to discern LTBI from false positives among those with lower quantitative tuberculin skin test results.

引用

页数：10

共 32 条

[1] Incidence of occupational latent tuberculosis infection in South African healthcare workers [J].