McCarthy K M, Scott L E, Gous N, Tellie M, Venter W D F, Stevens W S, Van Rie A
Wits Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; The Aurum Institute, Parktown, Johannesburg, South Africa; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Department of Molecular Diagnostics, National Health Laboratory Service and University of the Witwatersrand, Johannesburg, South Africa.
Int J Tuberc Lung Dis. 2015 Jun;19(6):647-53. doi: 10.5588/ijtld.14.0759.
In South Africa, health care workers (HCWs) are at two-fold greater risk of acquiring tuberculosis (TB) disease than the general population. Few studies have evaluated the risk of incident tuberculous infection.
To determine the incidence and risk factors for latent tuberculous infection (LTBI) among HCWs and to compare the results of the interferon-gamma release assay (IGRA) with those of the tuberculin skin test (TST).
HCWs, including medical students, underwent a TST and human immunodeficiency virus (HIV) and IGRA testing at baseline and 12 months, and IGRA at 6 months. The participants kept 12-month TB exposure logs.
Among 199 participants (150 [76%] females, median age 31 years [range 20-61]), incident LTBI was documented using IGRA in 25/97 (26%; incident rate 29 cases/100 person-years [py], 95%CI 20-44) and using TST in 25/93 (27%; incident rate 29 cases/100 py, 95%CI 19-42). Agreement between TST and IGRA was poor (44.8%, κ = 0.23). Higher annual exposure to TB cases was reported among persons with LTBI than in those who were persistently IGRA-negative (81 cases, 95%CI 61-102 vs. 50 cases, 95%CI 43-57, P < 0.01).
The high LTBI incidence and the association of incident LTBI with annual TB caseload among HCWs indicate that more effective TB infection control should be implemented in South African health care facilities.
在南非，医护人员感染结核病的风险是普通人群的两倍。很少有研究评估潜伏结核感染的风险。
确定医护人员中潜伏结核感染（LTBI）的发病率和危险因素，并比较干扰素-γ释放试验（IGRA）与结核菌素皮肤试验（TST）的结果。
包括医学生在内的医护人员在基线和12个月时接受了TST、人类免疫缺陷病毒（HIV）和IGRA检测，并在6个月时接受了IGRA检测。参与者记录了12个月的结核病接触日志。
在199名参与者中（150名[76%]为女性，中位年龄31岁[范围20 - 61岁]），使用IGRA记录到25/97（26%）发生LTBI（发病率为29例/100人年[py]，95%CI 20 - 44），使用TST记录到25/93（27%）发生LTBI（发病率为29例/100 py，95%CI 19 - 42）。TST和IGRA之间的一致性较差（44.8%，κ = 0.23）。LTBI患者报告的每年接触结核病例数高于持续IGRA阴性者（81例，95%CI 61 - 102 vs. 50例，95%CI 43 - 57，P < 0.01）。
医护人员中LTBI的高发病率以及LTBI与每年结核病例数的关联表明，南非医疗机构应实施更有效的结核感染控制措施。
