High risk for latent tuberculosis infection among medical residents and nursing students in India

Aarti Kinikar, Ajay Chandanwale, Dileep Kadam, Samir Joshi, Anita Basavaraj, Geeta Pardeshi, Sunita Girish, Sangeeta Shelke, Andrea Deluca, Gauri Dhumal, Jonathan E Golub, Nilima Lokhande, Nikhil Gupte, Amita Gupta, Robert C Bollinger, Vidya Mave

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Abstract

Defining occupational latent tuberculosis infection (LTBI) risk among healthcare workers is needed to support implementation of prevention guidelines. Prospective cohort study of 200 medical residents and nursing students in India was conducted May 2016-December 2017. Tuberculin skin test (TST) and QuantiFERON TB Gold Test-in-tube (QFT-GIT) were performed at study entry and 12 months. Primary outcome was incident LTBI (≥10mm TST induration and/or ≥0.35IU/mL QFT-GIT) at 12 months; secondary outcomes included baseline LTBI prevalence and risk factors for incident and prevalent LTBI using Poisson regression. Among 200, [90 nursing students and 110 medical residents], LTBI prevalence was 30% (95% CI, 24-37); LTBI incidence was 26.8 (95% CI, 18.6-37.2) cases per 100 personyears and differed by testing method (28.7 [95% CI, 20.6-38.9] vs 17.4 [95% CI, 11.5-25.4] cases per 100 person-years using TST and QFT-GIT, respectively). Medical residents had two-fold greater risk of incident LTBI than nursing students (Relative Risk, 2.16; 95% CI, 1.05-4.42). During study period 6 (3%) HCWs were diagnosed with active TB disease. Overall, median number of self-reported TB exposures was 5 (Interquartile Range, 1-15). Of 60 participants with prevalent and incident LTBI who were offered free isoniazid preventive therapy (IPT), only 2 participants initiated and completed IPT. High risk for LTBI was noted among medical residents compared to nursing students. Self-reported TB exposure is underreported, and uptake of LTBI prevention therapy remains low. New approaches are needed to identify HCWs at highest risk for LTBI.

Original languageEnglish (US)
Article numbere0219131
JournalPloS one
Volume14
Issue number7
DOIs
Publication statusPublished - Jan 1 2019

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ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Kinikar, A., Chandanwale, A., Kadam, D., Joshi, S., Basavaraj, A., Pardeshi, G., ... Mave, V. (2019). High risk for latent tuberculosis infection among medical residents and nursing students in India. PloS one, 14(7), [e0219131]. https://doi.org/10.1371/journal.pone.0219131