Sequential strategy for the LTBI screening of newly-arrived immigrants in vulnerable social situations
Enferm Infecc Microbiol Clin (Engl Ed). 2018 Nov;36(9):550-554.
doi: 10.1016/j.eimc.2017.10.010.
Epub 2017 Dec 7.
[Article in
English,
Spanish]
Affiliations
- 1 Unidad de Medicina Tropical y Salud Internacional Vall d'Hebron-Drassanes, Hospital Vall d'Hebron, Institut Català de la Salut, PROSICS, Barcelona, España. Electronic address: n.serre@vhebron.net.
- 2 Unidad de Medicina Tropical y Salud Internacional Vall d'Hebron-Drassanes, Hospital Vall d'Hebron, Institut Català de la Salut, PROSICS, Barcelona, España.
- 3 Servicio de Microbiología, Hospital Vall d'Hebron, Institut Català de la Salut, PROSICS, Barcelona, España.
- 4 Agència de Salut Pública de Barcelona, Barcelona, España.
- 5 Unidad de Patología Infecciosa e Inmunodeficiencias Pediátricas, Unidad de Medicina Tropical y Salud Internacional Vall d'Hebron-Drassanes, Servicio de Pediatría, Hospital Vall d'Hebron, Institut Català de la Salut, PROSICS, Barcelona, España.
- 6 Servicio de Infecciosas, Hospital Vall d'Hebron, Institut Català de la Salut, PROSICS, Barcelona, España.
- 7 Departament Fonaments Clínic, Universitat de Barcelona, Institut de Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España.
Abstract
Introduction:
Some studies indicate high prevalences of latent tuberculosis infection (LTBI) in the immigrant population, which is relevant because 5-10% of cases will develop active tuberculosis. The objective of this study is to describe the results of a sequential strategy in the newly-arrived immigrant population for the diagnosis of LTBI using the tuberculin skin test (TST) and IGRAs.
Methods:
A retrospective descriptive study was carried out with immigrants between 6 and 35years of age from shelters, referred to an international health unit between July 2013 and June 2016. The TST was performed and when it was ≥5mm, IGRAs were conducted. LTBI was defined as an IGRA ≥0.35IU/ml and normal chest X-ray.
Results:
Of the 184 cases, 138 (75.0%) were men, 23.0 years of age. The most common geographical areas were: 63 (34.2%) from Asia, 42 (22.8%) from Eastern Europe and 41 (22.3%) from sub-Saharan Africa. The TST was ≥10mm in 79 cases (42.9%). The prevalence of LTBI using the sequential strategy was 33/184 (17.9%). Cohen's Kappa index (between TST≥10mm and IGRAs) was 0.226.
Conclusion:
Basing LTBI screening on the TST alone could give rise to an overestimation. Some studies show that sequential screening would be the most cost-effective; this seems most evident in BCG-vaccinated populations.
Keywords:
Cribado; Immigrants; Infección tuberculosa latente; Inmigrantes; Interferon Gamma Release Assays; Latent tuberculosis infection; Prueba de tuberculina; Screening; Tuberculosis; Tuberculosis skin test.
Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
MeSH terms
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Adolescent
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Adult
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Africa South of the Sahara / ethnology
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Asia / ethnology
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BCG Vaccine
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Cost-Benefit Analysis
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Emigrants and Immigrants*
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Europe, Eastern / ethnology
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Female
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Humans
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Interferon-gamma Release Tests / economics
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Latent Tuberculosis / diagnosis*
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Latent Tuberculosis / ethnology
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Latin America / ethnology
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Male
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Mass Screening / economics
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Mass Screening / methods*
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Prevalence
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Retrospective Studies
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Social Determinants of Health
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Spain / epidemiology
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Tuberculin Test / economics
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Vaccination / statistics & numerical data
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Vulnerable Populations*
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Young Adult