Late Boosting Phenomenon in TST Conversion Among Health Care Workers

Details

• Personal Author:
  Breeher LE ; Farah WH ; Hagen PT ; Molella RG ; Murad MH ; Newcomb RD ; Vaughn AIS
• Description:
  Background: Available information is insufficient to guide determination of whether tuberculin skin test (TST) conversions of health care workers (HCWs) within 2 years of two-step testing are related to occupational exposures or to other causes, including late boosting. Aims: To describe the epidemiologic factors of TST conversion in HCWs, comparing early TST conversion (≤2 years after two-step testing) with late conversion to possibly distinguish late boosting phenomenon from occupational TST conversion. Methods: Retrospective analysis of a database of TSTs of HCWs from 1 January 1998, through 31 May 2014, in the United States Midwest. Results: In total, 40142 HCWs had 197932 tests over the 16 years, with 123 conversions (conversion rate: 0.3%; 95% CI 0.3-0.4%). Among 61 HCWs with a negative two-step TST, 30 (49%) were found to have early TST conversion within 2 years; 31 (51%) had late conversion, with likely occupational exposure but no identifiable community risks. Persons with early conversion were more likely to be born outside the USA (89% versus 57%; P < 0.05), had a higher rate of prior bacille Calmette-Guérin (BCG) vaccination (89% versus 52%; P < 0.05) and had no identifiable risk factors for conversion (63% versus 58%; P < 0.05). Conclusions: Early conversions among HCWs after negative two-step TST are associated with various nonoccupational factors, including international birth and BCG vaccination history. Therefore, conversion is not a reliable indicator of recent tuberculosis contact in this population, and two-step TST is insufficient to discount a delayed boosting response for HCWs. [Description provided by NIOSH]
• Subjects:
  Health Personnel Occupational Exposure Occupational Health Safety Skin Tuberculosis
• Keywords:
  Author Keywords: Boosting Phenomenon; Health Care Workers; Latent Tuberculosis; Skin Test Health Care Workers; Occupational Exposure; Tuberculosis; TB; Skin Tests; Bacterial Disease; Vaccines;
• DOI:
  https://doi.org/10.1093/occmed/kqx102
• ISSN:
  0962-7480
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Minnesota ; OSHA Region 3 ; OSHA Region 5 ; Pennsylvania
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  484-489
• Volume:
  67
• Issue:
  6
• NIOSHTIC Number:
  nn:20065296
• Citation:
  Occup Med 2017 Aug; 67(6):484-489
• Contact Point Address:
  R. G. Molella, Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
• Email:
  molella.robin@mayo.edu
• Federal Fiscal Year:
  2017
• Performing Organization:
  University of Pennsylvania, Philadelphia
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Occupational Medicine
• End Date:
  20290630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:817ff70454e8a47b795a051f0b4ab96b95614f37079f29ac79f8f5fafbd086936949ee450b05aa72d6779ae044501912102d7ca2cff49d6f16b6abff8e8c189c
• Download URL:
  https://stacks.cdc.gov/view/cdc/248901/cdc_248901_DS1.pdf
• File Type:
  [PDF - 655.10 KB ]