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Enferm Infecc Microbiol Clin. 2018 Nov;36(9):550-554. doi: 10.1016/j.eimc.2017.10.010. Epub 2017 Dec 7.

Sequential strategy for the LTBI screening of newly-arrived immigrants in vulnerable social situations.

[Article in English, Spanish]

Author information

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

PMID:
29223317
DOI:
10.1016/j.eimc.2017.10.010

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