Durando Paolo, Sotgiu Giovanni, Spigno Fabio, Piccinini Mauro, Mazzarello Giovanni, Viscoli Claudio, Copello Francesco, Poli Alessandro, Ansaldi Filippo, Icardi Giancarlo
Department of Health Sciences, Associate Professor of Hygiene, Preventive Medicine and Public Health, Hygiene Unit, IRCCS AOU San Martino-IST teaching Hospital, University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy.
BMC Infect Dis. 2013 Sep 23;13:443. doi: 10.1186/1471-2334-13-443.
The screening of both healthcare workers and students attending teaching hospitals for latent tuberculosis infection (LTBI) is recommended in hospitals of many countries with a low-incidence of TB, including Italy, as a fundamental tool of tuberculosis (TB) control programs. The aim of the study was to estimate the prevalence of LTBI and evaluate the main risk-factors associated with this condition in a cohort of healthcare Italian students.
In a cross-sectional study, performed between January and May 2012, 881 undergraduate students attending the Medical, Nursing, Pediatric Nursing and Midwifery Schools of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the Tuberculin Skin Test (TST). All the TST positive cases were also tested with an Interferon-Gamma Release Assay (IGRA) to confirm the diagnosis of LTBI. A standardized questionnaire was collected for risk-assessment analysis.
Seven hundred and thirty-three (83.2%) subjects underwent TST testing. The prevalence of TST positives was 1.4%, and in 4 (0.5%) out of 10 TST positive cases LTBI diagnosis was confirmed by IGRA. No difference in the prevalence of subjects who tested positive to TST emerged between pre-clinical (n = 138) and clinical (n = 595) students. No statistically significant association between TST positivity and age, gender, and BCG vaccination was observed. The main independent variable associated with TST positivity was to be born in a country with a high TB incidence (i.e., ≥20 cases per 100,000 population) (adjusted OR 102.80, 95% CI 18.09-584.04, p < 0.001).
The prevalence of LTBI among healthcare students resulted very low. The only significant association between TST positivity and potential risk factors was to be born in high TB incidence areas. In countries with a low incidence of TB, the screening programs of healthcare students before clinical training can be useful for the early identification and treatment of the sporadic cases of LTBI.
在包括意大利在内的许多结核病低发国家的医院，建议对教学医院的医护人员和学生进行潜伏性结核感染（LTBI）筛查，作为结核病（TB）控制项目的一项基本工具。本研究的目的是估计意大利医护专业学生队列中LTBI的患病率，并评估与该疾病相关的主要风险因素。
在2012年1月至5月进行的一项横断面研究中，积极邀请了881名就读于热那亚大学医学、护理、儿科护理和助产学校且在热那亚IRCCS圣马蒂诺-IST教学医院接受培训的本科学生接受结核菌素皮肤试验（TST）。所有TST阳性病例还接受了干扰素-γ释放试验（IGRA）检测，以确诊LTBI。收集标准化问卷进行风险评估分析。
733名（83.2%）受试者接受了TST检测。TST阳性率为1.4%，10例TST阳性病例中有4例（0.5%）经IGRA确诊为LTBI。临床前（n = 138）和临床（n = 595）学生中TST检测阳性的受试者患病率无差异。未观察到TST阳性与年龄、性别和卡介苗接种之间存在统计学显著关联。与TST阳性相关的主要独立变量是出生在结核病高发国家（即每10万人口中≥20例）（调整后的OR为102.80，95%CI为18.09 - 584.04，p < 0.001）。
医护专业学生中LTBI的患病率非常低。TST阳性与潜在风险因素之间唯一显著的关联是出生在结核病高发地区。在结核病低发国家，临床培训前对医护专业学生进行筛查项目有助于早期识别和治疗LTBI散发病例。
