High Rate of Negative Results of Tuberculin and QuantiFERON Tests Among Individuals with a History of Positive Skin Test Results

Details

• Personal Author:
  Bryant J ; Cain HC ; D'Amato J ; Edberg SC ; Friedman LN ; Henry S ; Khaled GH ; Nash ER ; O'Connor PG ; Pisani MA ; Russi MB ; Shi J ; Tanoue L ; Weissman, David N.
• Description:
  Objectives. To evaluate individuals at high risk for tuberculosis exposure who had a history of a positive tuberculin skin test (TST) result in order to determine the prevalence of unsuspected negative TST results. To confirm these findings with the QuantiFERON-TB test (QFT), an in vitro whole-blood assay that measures tuberculin-induced secretion of interferon-gamma. Methods. This survey was conducted from November 2001 through December 2003 at 3 sites where TST screening is regularly done. Detailed histories and reviews of medical records were performed. TSTs were placed and read by 2 experienced healthcare workers, and blood was drawn for QFT. Any subject with a negative result of an initial TST during the study (induration diameter, < 10 mm) underwent a second TST and a second QFT. The TST-negative group comprised individuals for whom both TSTs had an induration diameter of < 10 mm. The confirmed-negative group comprised individuals for whom both TSTs yielded no detectable induration and results of both QFTs were negative. Results. A total of 67 immunocompetent subjects with positive results of a previous TST were enrolled in the study. Of 56 subjects who completed the TST protocol, 25 (44.6%; 95% confidence interval [CI], 31.6%-57.6%) were TST negative (). Of 31 subjects P <.001 who completed the TST protocol and the QFT protocol, 8 (25.8%; 95% CI, 10.4%-41.2%) were confirmed negative (). P <.005 conclusions. A significant proportion of subjects with positive results of a previous TST were TST negative in this study, and a subset of these were confirmed negative. These individuals' TST status may have reverted or may never have been positive. It will be important in future studies to determine whether such individuals lack immunity to tuberculosis and whether they should be considered for reentry into tuberculosis screening programs. [Description provided by NIOSH]
• Subjects:
  Blood Hematologic Tests Occupational Health Risk Assessment Risk Factors Safety
• Keywords:
  Analytical-methods Analytical-models Blood-tests Immunodiagnosis Immunological-tests In-vitro-studies Risk-analysis Risk-factors Screening-methods Screening-programs Statistical-analysis

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• ISSN:
  0899-823X
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Connecticut ; Massachusetts ; OSHA Region 1 ; OSHA Region 3 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  436-441
• Volume:
  27
• Issue:
  5
• NIOSHTIC Number:
  nn:20032686
• Citation:
  Infect Control Hosp Epidemiol 2006 May; 27(5):436-441
• Contact Point Address:
  LN Friedman, Yale University, School of Medicine, Yale New Haven Hospital, New Haven, CT 06520
• Federal Fiscal Year:
  2006
• Peer Reviewed:
  True
• Source Full Name:
  Infection Control and Hospital Epidemiology
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f825d572defdaab15a6e100f82b2c16506ee01699e9e533bdb801770b5dd7f1e02849f7a677a764fd2103fbf1337ab8d24f5b82d3b370d7d77f5b99baec7ea54
• Download URL:
  https://stacks.cdc.gov/view/cdc/186571/cdc_186571_DS1.pdf
• File Type:
  [PDF - 532.09 KB ]