Tuberculin skin testing and QuantiFERON™-TB Gold Plus positivity among household contacts in Vietnam.

IF 1.3 Q4 RESPIRATORY SYSTEM Public Health Action Pub Date : 2023-09-21 DOI:10.5588/pha.23.0020

A L Innes, S T Nguyen, V Lebrun, T T H Nguyen, T P Huynh, V L Quach, G L Hoang, T B Nguyen, T B P Nguyen, H M Pham, A Martinez, N Dinh, V L Dinh, B H Nguyen, T T H Truong, V C Nguyen, V N Nguyen, T H Mai

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Abstract

Setting: TB infection (TBI) is diagnosed using the technique-dependent tuberculin skin test (TST) or costly, more accurate interferon-gamma release assays. The TST (⩾10 mm) threshold was indicated by previous research among household contacts in Vietnam, but routine implementation with a different tuberculin reagent showed unexpectedly low TST positivity.

Objective: TST (⩾5 mm and ⩾10 mm) results were compared to QuantiFERON™-TB Gold Plus (QFT) results in household contacts during community campaigns in 2020 and 2021.

Design: This was a cross-sectional multi-center implementation study.

Results: Among 1,330 household contacts in 2020, we found a TBI prevalence of 38.6% (QFT), similar to TST ⩾5 mm (37.4%) and higher than TST ⩾10 mm (13.1%). QFT+/TST+ was higher for TST ⩾5 mm (20.7%) than TST ⩾10 mm (9.4%). QFT was not discordant with TST ⩾5 mm (McNemar's test = 0.6, P = 0.5) but was discordant with TST ⩾10 mm (McNemar's test = 263.9, P < 0.01). Older age and Southern region increased odds for positive TST ⩾5 mm and QFT with weaker associations for TST ⩾10 mm. Agreement and discordance were similar in 2021 for 1,158 household contacts.

Conclusion: Tuberculin reagents affect TST positivity rates. High TB burden countries should monitor reliability of TBI diagnosis, including tuberculin potency, cold chain, and TST technique to optimize eligibility for TB preventive treatment.

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结核菌素皮肤测试和QuantiFERON™-越南家庭接触者中TB Gold Plus阳性。

背景：结核病感染（TBI）是使用技术依赖性结核菌素皮肤试验（TST）或昂贵、更准确的干扰素γ释放测定来诊断的。先前在越南家庭接触者中进行的研究表明了TST（⩾10mm）阈值，但使用不同结核菌素试剂的常规实施显示出出乎意料的低TST阳性率。目的：将TST（5 mm和10 mm）结果与QuantiFERON进行比较™-TB Gold Plus（QFT）在2020年和2021年的社区活动中导致了家庭接触。设计：这是一项跨部门的多中心实施研究。结果：在2020年的1330名家庭接触者中，我们发现TBI的患病率为38.6%（QFT），类似于TST 5 mm（37.4%），高于TST 10 mm（13.1%）。5 mm（20.7%）的QFT+/TST+高于10 mm（9.4%T⩾10毫米。2021年，1158名家庭接触者的一致性和不一致性相似。结论：结核菌素试剂影响TST阳性率。高结核病负担国家应监测结核病I诊断的可靠性，包括结核菌素效力、冷链和TST技术，以优化结核病预防性治疗的资格。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.