Skip to main content

Advertisement

Log in

Evaluation of the interferon-γ release assay in healthcare workers

  • Original Article
  • Published:
International Archives of Occupational and Environmental Health Aims and scope Submit manuscript

Abstract

Objectives

An in vitro test for the diagnosis of latent TB-infection (LTBI) is now available that has the potential to replace the tuberculin skin test (TST). The new test measures the cell-mediated immune response to TB antigens. Little experience is currently available on the performance of the IGRA when testing HCW for LTBI. Therefore the aim of the study was to compare the IGRA with the TST in testing HCW for LTBI.

Methods

The medical staffs of three hospitals were simultaneously tested with TST (RT23) and IGRA (QFT). The study comprises 261 HCW, all exposed to active TB-patients. Information on gender, age, workplace, BCG vaccination and history of both TB and TST were collected using a standardised questionnaire.

Results

The TST was positive in 24.1% and the IGRA in 9.6% of the participants. Agreement between the tests was low in HCW with a BCG-vaccination. A history of an earlier TST was a risk factor for a positive TST but not for a positive IGRA. Out of 48 results positive in the TST but negative in the IGRA 97.8% might be explained by BCG vaccination or an earlier TST. A positive association between age and LTBI was observed for the IGRA but not for the TST results. Out of 25 positive results in the IGRA only 60% were recognized by the TST, too. The HCW with a positive IGRA and a negative TST had the same age (mean 49.1) as the HCW positive in both tests (mean 50.9), which was higher than the age of those negative in both tests (mean 38.8).

Conclusions

The data indicate that the IGRA should replace the TST in serial testing of HCW in high income, low incidence countries. The recommendations to use the IGRA in order to verify a positive TST only should be reconsidered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Andersen P, Munk ME, Pollock JM, Doherty TM (2000) Specific immune-based diagnosis of tuberculosis. Lancet 356(9235):1099–1104

    Article  PubMed  CAS  Google Scholar 

  • ATS —American Thoracic Society (2000) Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 161(4 Pt 2):S221–S247

    Google Scholar 

  • BTS —Joint Tuberculosis Committee of the British Thoracic Society (2000) Control and prevention of tuberculosis in the United Kingdom: code of practice 2000. Thorax 55:887–901

    Article  Google Scholar 

  • CDC (2005) Guidelines for the investigation of contacts of persons with infectious tuberculosis: recommendations from the National Tuberculosis Controllers Association and CDC. MMWR 54:1–37

    Google Scholar 

  • Diel R, Ernst M, Doscher G, Visuri-Karbe L, Greinert U, Niemann S, Nienhaus A, Lange C (2006a) Avoiding the effect of BCG vaccination in detecting Mycobacterium tuberculosis infection with a blood test. Eur Respir J 28(1):16–23

    Article  PubMed  CAS  Google Scholar 

  • Diel R, Nienhaus A, Lange C, Schaberg T (2006b) Cost-optimisation of screening for latent tuberculosis in close contacts. Eur Respir J 28(1):35–44

    Article  PubMed  CAS  Google Scholar 

  • Harada N, Nakajima Y, Higuchi K, Sekiya Y, Rothel J, Mori T (2006) Screening for tuberculosis infection using whole-blood interferon-γ and Mantoux testing among Japanese healthcare workers. Infect Control Hosp Epidemiol 27(5): 442–448

    Article  PubMed  Google Scholar 

  • Hosmer D, Lemeshow S (2000) Applied logistic regression. Wiley, New York

    Google Scholar 

  • Lange C, Schaberg T, Diel R, Greinert U (2006) Current concepts in the diagnosis of tuberkulosis. Deutsch Med Wochenschr 131:341–347

    Article  CAS  Google Scholar 

  • Mahairas GG, Sabo PJ, Hickey MJ, Singh DC, Stover CK (1996) Molecular analysis of genetic differences between Mycobacterium bovis BCG and virulent M. bovis. J Bacteriol 178(5):1274–1282

    PubMed  CAS  Google Scholar 

  • Mazurek GH, Hereb J, Lobue P, Iademarco MF, Metchock B, Vernon A (2005) Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep 54(RR-15):49–55

    PubMed  Google Scholar 

  • Menzies D, Pai M, Comstock G (2007) Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med 146:340–354

    PubMed  Google Scholar 

  • Menzies D (2000) What does tuberculin reactivity after Bacille Calmette–Guerin vaccination tell us? Clin infect Dis 31(Suppl 3):S71–74

    Article  PubMed  Google Scholar 

  • Nahid P, Pai M, Hopewell PC (2006) Advances in the diagnosis and treatment of tuberculosis. Proc Am Thorac Soc 3:103–110

    Article  PubMed  CAS  Google Scholar 

  • NICE —National Institute for Health and Clinical Excellence (2006) Clinical Guideline 33. Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control. NICE, London, UK. http://www.nice.org.uk

  • Pai M (2005) Alternatives to the tuberculin skin test: interferon-γ assays in the diagnosis of Mycobacterium tuberculosis infection. Indian J Med Microbiol 23(3): 151–158

    Article  PubMed  CAS  Google Scholar 

  • Pai M, Gokhale K, Joshi R, Dogra S, Kalantri S, Mendiratta D, Narang P, Daley C, Granich R, Mazurek G, Reingold A, Riley L, Colford J (2005) Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole-blood interferon gamma assay with tuberculin skin testing. JAMA 293:2746–2755

    Article  PubMed  CAS  Google Scholar 

  • Pai M, Kalantri S, Dheda K (2006a) New tools and emerging technologies for the diagnosis of tuberculosis: Part I. Latent tuberculosis. Expert Rev Mol Diagn 6(3):413–422

    Article  PubMed  CAS  Google Scholar 

  • Pai M, Joshi R, Dogra S, Mendriatta D, Narang P, Kalantri S, Reingold A, Colford J, Riley L, Menzies D (2006b) Serial testing of health care workers for tuberculosis using interferon-γ assay. AJRCCM 174(3):349–355

    CAS  Google Scholar 

  • RKI —Robert Koch-Institut (2006) Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2004 (Report of the Epidemiology of Tuberculosis in Germany 2004), Berlin

  • Singh D, Sutton C, Woodcock A (2001) Repeat tuberculin testing in BCG-vaccinated subjects in the United Kingdom. The booster effect varies with the time of reading. Am J Respir Crit Care Med 164(6):962–964

    PubMed  CAS  Google Scholar 

  • Stop TB Partnership, WHO (2006) The Global Plan to Stop TB 2006–2015. WHO Geneva, Switzerland

  • Von Pirquet C (1909) Frequency of tuberculosis in children JAMA LII (9)

  • WHO (2005) Global tuberculosis control. Surveillance, planning, financing. WHO Report 2005, Geneva, Switzerland, pp 1–247

Download references

Acknowledgments

We thank Ms G. Beckmann, Ms S. Nausester, and Ms. R. Sternfeldt for the medical examinations and the data collection. The study was fully paid for by the Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services. The authors do not have any competing interests.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Nienhaus.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nienhaus, A., Schablon, A., Bâcle, C.L. et al. Evaluation of the interferon-γ release assay in healthcare workers. Int Arch Occup Environ Health 81, 295–300 (2008). https://doi.org/10.1007/s00420-007-0212-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00420-007-0212-1

Keywords

Navigation