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Is latent tuberculosis infection challenging in Iranian health care workers? A systematic review and meta-analysis.

ABSTRACT: BACKGROUND:The high chances of getting latent tuberculosis infection (LTBI) among health care workers (HCWs) will an enormous problem in low and upper-middle-income countries. METHOD:Search strategies were done through both national and international databases include SID, Barakat knowledge network system, Irandoc, Magiran, Iranian national library, web of science, Scopus, PubMed/MEDLINE, OVID, EMBASE, the Cochrane library, and Google Scholar search engine. The Persian and the English languages were used as the filter in national and international databases, respectively. Medical Subject Headings (MeSH) terms was used to controlling comprehensive vocabulary. The search terms were conducted without time limitation till January 01, 2019. RESULTS:The prevalence of LTBI in Iranian's HCWs, based on the PPD test was 27.13% [CI95%: 18.64-37.7]. The highest prevalence of LTBI in Iranian's HCWs were estimated 41.4% [CI95%: 25.4-59.5] in the north, and 33.8% [CI95%: 21.1-49.3] in the west. The lowest prevalence of LTBI was evaluated 18.2% [CI95%: 3.4-58.2] in the south of Iran. The prevalence of LTBI in Iranian's HCWs who had work-experience more than 20 years old were estimated 20.49% [CI95%: 11-34.97]. In the PPD test, the prevalence of LTBI in Iranian's HCWs who had received the Bacille Calmette-Guérin (BCG) was estimated 15% [CI95%: 3.6-47.73]. While, in the QFT, the prevalence of LTBI in Iranian's HCWs in non-vaccinated was estimated 25.71% [CI95%: 13.96-42.49]. CONCLUSIONS:This meta-analysis shows the highest prevalence of LTBI in Iranian's HCWs in the north and the west probably due to neighboring countries like Azerbaijan and Iraq, respectively. It seems that Iranian's HCWs have not received the necessary training to prevent of TB. We also found that BCG was not able to protect Iranian's HCWs from TB infections, completely.

SUBMITTER: YektaKooshali MH

PROVIDER: S-EPMC6776393 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Is latent tuberculosis infection challenging in Iranian health care workers? A systematic review and meta-analysis.

YektaKooshali Mohammad Hossein MH Movahedzadeh Farahnaz F Foumani Ali Alavi AA Sabati Hoda H Jafari Alireza A

PloS one 20191003 10

<h4>Background</h4>The high chances of getting latent tuberculosis infection (LTBI) among health care workers (HCWs) will an enormous problem in low and upper-middle-income countries.<h4>Method</h4>Search strategies were done through both national and international databases include SID, Barakat knowledge network system, Irandoc, Magiran, Iranian national library, web of science, Scopus, PubMed/MEDLINE, OVID, EMBASE, the Cochrane library, and Google Scholar search engine. The Persian and the Eng ...[more]

PMID: 31581258

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Project description:Tuberculosis is one of the leading causes of death worldwide. Twenty-two high burden countries contributed to the majority of worldwide tuberculosis cases in 2015. Health care workers are at high risk of acquiring tuberculosis through occupational exposure.To estimate the prevalence of latent tuberculosis infection (LTBI) among health care workers in high burden countries.Databases including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (Ovid) and ISI Web of Science (Thompson-Reuters), and grey literature were searched for English language records on relevant medical subject headings (MeSH) terms of LTBI and health care providers. Literature was systematically reviewed using EPPI-Reviewer4 software. Prevalence and incidence of LTBI and 95% confidence intervals (CI) were reported. Pooled prevalence of LTBI and 95% CI were calculated using random-effects meta-analysis models and heterogeneity was assessed using I2 statistics. Sub-group analysis was conducted to assess the cause of heterogeneity.A total of 990 records were identified. Of those, 18 studies from only 7 high burden countries representing 10,078 subjects were included. Tuberculin skin test results were available for 9,545 participants. The pooled prevalence of LTBI was 47% (95% CI 34% to 60%, I2 = 99.6%). In subgroup analyses according to the country of the study, the pooled prevalence of LTBI was lowest in Brazil (37%) and highest in South Africa (64%). The pooled prevalence of LTBI among medical and nursing students was 26% (95% CI 6% to 46%, I2 = 99.3%) while the prevalence among all types of health care workers was 57% (95% CI 44% to 70%, I2 = 99.1%). Incidence of LTBI was available for health care workers in four countries. The cumulative incidence ranged from 2.8% in Brazilian medical students to 38% among all types of health care workers in South Africa.The findings of this study suggest that there is a high burden of LTBI among health care workers in high burden countries. Adequate infection control measures are warranted to prevent and control transmission in health care settings.

Project description:The laboratory diagnosis of latent tuberculosis infection (LTBI) is mainly performed with interferon gamma release assays (IGRAs). We compared the performance of a new enzyme-linked immunosorbent assay (ELISA)-based IGRA, the Standard E TB-Feron ELISA (TBF; SD Biosensor, Gyeonggi-do, Republic of Korea), with that of a widely used assay, the QuantiFERON-TB Gold In-Tube assay (QFT-GIT; Qiagen, Hilden, Germany), in a population of 425 health care workers (HCWs). All HCWs were screened by both assays per the manufacturers' protocols and in a cross-manner, where tube sets from one assay were used with the alternative ELISA. The results were compared both qualitatively and quantitatively. TBF and QFT-GIT identified 11.3% (48/425) and 12.9% (55/425) of the positive samples, respectively. TBF demonstrated 81.6% positive and 97.4% negative percent agreement with QFT-GIT, with a Cohen's kappa value of 0.78 (strong agreement). Discordant results were detected in 20 subjects (4.3%): 13 samples (65.0%) were TBF negative and QFT-GIT positive, 6 samples (30.0%) were TBF positive and QFT-GIT negative, and 1 sample provided TBF and QFT-GIT indeterminate/negative results. We observed a statistically significant degree of correlation between the interferon gamma reactivity between the two assays (Spearman's rho [rs ] value = 0.551, P?<?0.01) and between standard assays and cross-manner tests (rs value range, 0.449 to 0.816; P?<?0.01 for all combinations). Cross-manner tests also revealed that the ELISA kit of TBF provided higher values for the tube containing the tuberculosis (TB) antigen and the negative-control tube than the ELISA of QFT-GIT under the same conditions (P?<?0.01), although these differences disappeared when the value for the negative-control tube was subtracted from that for the TB antigen tube. TBF showed a comparable and acceptable clinical performance in detecting LTBI compared to QFT-GIT. TBF represents a useful alternative tool as an ELISA-based IGRA, especially for large-scale screening for LTBI in HCWs.

Project description:CONTEXT:Latent tuberculosis infection diagnosis and treatment is a strategic priority for eliminating tuberculosis in the U.S. The Centers for Disease Control and Prevention has recommended the short-course regimen of 3-month isoniazid-rifapentine administered by directly observed therapy. However, longer-duration regimens remain the most widely prescribed latent tuberculosis infection treatments. Limitation on adoption of 3-month isoniazid-rifapentine in the U.S. might be because of patients' preference for self-administered therapy, providers' lack of familiarity with 3-month isoniazid-rifapentine, or lack of resources to support directly observed therapy. This review examines the most recent evidence regarding 3-month isoniazid-rifapentine's effectiveness, safety, and treatment completion when directly compared with other latent tuberculosis infection regimens primarily comprising 9-month isoniazid treatment. EVIDENCE ACQUISITION:Using Community Guide methodology, reviewers identified, evaluated, and summarized available evidence published during January 2006-June 2017. Analysis of the data was completed in 2017. EVIDENCE SYNTHESIS:The analysis included 15 unique studies. Three-month isoniazid-rifapentine was determined to be equal to other latent tuberculosis infection regimens in effectiveness (OR=0.89, 95% CI=0.46, 1.70), and has higher treatment completion (87.5%, 95% CI=83.2%, 91.3%) compared with other latent tuberculosis infection regimens (65.9%, 95% CI=53.5%, 77.3%). Three-month isoniazid-rifapentine was associated with similar risk to other latent tuberculosis infection regimens for adverse events (relative risk=0.59, 95% CI=0.23, 1.52); discontinuing treatment because of adverse events (relative risk=0.48, 95% CI=0.17, 1.34); and death (relative risk=0.79, 95% CI=0.56, 1.11). CONCLUSIONS:The 3-month isoniazid-rifapentine regimen is as safe and effective as other recommended latent tuberculosis infection regimens and achieves significantly higher treatment completion rates.

Dataset Information

Is latent tuberculosis infection challenging in Iranian health care workers? A systematic review and meta-analysis.

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Is latent tuberculosis infection challenging in Iranian health care workers? A systematic review and meta-analysis.

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