Latent Tuberculosis in Healthcare Workers - the Reality of a Portuguese Tertiary Hospital
Study Details
Study Description
Brief Summary
Prospective, descriptive study to assess latent tuberculosis infection (LTBI) among healthcare worker (HCW) in a tertiary hospital in a low-risk area.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Detailed Description
identification and treatment of LTBI can substantially reduce the risk of development of disease and are important TB control strategies, especially in settings with a low tuberculosis (TB) incidence, where reactivation of LTBI often accounts for the majority of non-imported TB disease treatment of LTBI can substantially reduce the risk of development of disease.
In Portugal the real prevalence of LTBI in low-risk HCWs has not been evaluated since they are not included in the periodic screening programs. It is important to diagnose TB infections in HCWs to prevent nosocomial transmission, particularly among immunocompromised patients.
The risk for transmission varies by setting, occupational group, local prevalence of TB, patient population, and effectiveness of TB infection control measures.
Prevention of active TB disease by treatment of LTBI is a critical component for public health.
Tuberculin skin test (TST) is used worldwide to diagnose LTBI, whereas interferon-γ release assay (IGRA) are used in some countries according to their national TB programs. IGRA offers a potential method of serial testing to diagnose LTBI in HCWs, and it has better specificity than that of TST in one-time screening.
Study participants should be identified and contacted by occupational health service. In association, study information should be disseminated through posters and institutional email.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Healthcare workers Clinical evaluation, chest x-ray and Interferon-γ release assay (IGRA). Immunocompromised patients will be submitted to a tuberculin skin test. The patients will be evaluated in two or more separate appointments. In the first appointment, patients will be submitted to clinical evaluation and exam request. In the second appointment the results will be evaluated. |
Diagnostic Test: IGRA/Tuberculin skin test
All patients will receive:
Clinical evaluation;
Chest x-ray.
IGRA (or tuberculin skin test if immunocompromised)
Therapeutic proposal if eligible
|
Outcome Measures
Primary Outcome Measures
- Number and percentage of latent tuberculosis diagnosis in healthcare workers [1 year]
Patients with positive IGRA/tuberculin test screening and without clinical or radiological features of active Tuberculosis
Secondary Outcome Measures
- Treatment acceptance for latent tuberculosis [1 year]
Number of positive screening participants who accept and start treatment
- Treatment completion [1 year]
Number of patients who finished treatment
Other Outcome Measures
- Treatment discontinuation [1 year]
Number of patients who did not complete treatment
Eligibility Criteria
Criteria
Inclusion Criteria:
-
All HCW from our hospital with risk of exposure, working in our hospital for at least 3 consecutive months
-
Acceptance to participate and signed informed consent form
Exclusion Criteria:
-
History of previous tuberculosis
-
Active Tuberculosis
-
Refusal to sign the informed consent form
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Centro Hospitalar do Oeste - Torres Vedras | Torres Vedras | Lisboa | Portugal | 2560-295 |
Sponsors and Collaborators
- Centro Hospitalar do Oeste
Investigators
- Principal Investigator: Carina Rolo Silvestre, MD, MSc, Centro Hospitalar do Oeste
Study Documents (Full-Text)
None provided.More Information
Publications
- Adams S, Ehrlich R, Baatjies R, van Zyl-Smit RN, Said-Hartley Q, Dawson R, Dheda K. Incidence of occupational latent tuberculosis infection in South African healthcare workers. Eur Respir J. 2015 May;45(5):1364-73. doi: 10.1183/09031936.00138414. Epub 2015 Feb 19.
- Almufty HB, Abdulrahman IS, Merza MA. Latent Tuberculosis Infection among Healthcare Workers in Duhok Province: From Screening to Prophylactic Treatment. Trop Med Infect Dis. 2019 May 23;4(2):85. doi: 10.3390/tropicalmed4020085.
- Apriani L, McAllister S, Sharples K, Alisjahbana B, Ruslami R, Hill PC, Menzies D. Latent tuberculosis infection in healthcare workers in low- and middle-income countries: an updated systematic review. Eur Respir J. 2019 Apr 18;53(4):1801789. doi: 10.1183/13993003.01789-2018. Print 2019 Apr.
- Chen B, Gu H, Wang X, Wang F, Peng Y, Ge E, Upshur R, Dai R, Wei X, Jiang J. Prevalence and determinants of latent tuberculosis infection among frontline tuberculosis healthcare workers in southeastern China: A multilevel analysis by individuals and health facilities. Int J Infect Dis. 2019 Feb;79:26-33. doi: 10.1016/j.ijid.2018.11.010. Epub 2018 Nov 22.
- Costa JC, Silva R, Ferreira J, Nienhaus A. Active tuberculosis among health care workers in Portugal. J Bras Pneumol. 2011 Sep-Oct;37(5):636-45. doi: 10.1590/s1806-37132011000500011. English, Portuguese.
- Park Y, Kim SY, Kim JW, Park MS, Kim YS, Chang J, Kang YA. Serial testing of healthcare workers for latent tuberculosis infection and long-term follow up for development of active tuberculosis. PLoS One. 2018 Sep 20;13(9):e0204035. doi: 10.1371/journal.pone.0204035. eCollection 2018.
- LTBCHO23