TY - JOUR
T1 - T-SPOT.TB interferon-g release assay performance in healthcare worker screening at nineteen U.S. Hospitals
AU - King, Thomas C.
AU - Upfal, Mark
AU - Gottlieb, Andrew
AU - Adamo, Philip
AU - Bernacki, Edward
AU - Kadlecek, Chris P.
AU - Jones, Jeffrey G.
AU - Humphrey-Carothers, Frances
AU - Rielly, Albert F.
AU - Drewry, Pamela
AU - Murray, Kathy
AU - DeWitt, Marcie
AU - Matsubara, Janet
AU - O'Dea, Louis
AU - Balser, John
AU - Wrighton-Smith, Peter
N1 - Publisher Copyright:
© 2015 by the American Thoracic Society.
PY - 2015/8/1
Y1 - 2015/8/1
N2 - Rationale: Interferon-g release assays have significant advantages over tuberculin skin testing in many clinical situations. However, recent studies have called into question their reliability in serial testing of healthcare workers because of reportedly high rates of positivity and high conversion/reversion rates on retesting. Objectives: To define the performance characteristics of the T-SPOT.TBtest, an interferon-γ release assay, during serial screening programs of healthcare workers at 19 U.S. hospitals. Methods: A total of 42,155 T-SPOT.TB test results from healthcare workers at 19 geographically diverse hospitals obtained for routine tuberculosis screening programs were analyzed to determine the rates of positivity, reversion, and conversion in serial testing data. Measurements and Main Results: In 19,630 evaluable serial pairs from 16,076 healthcare workers, the mean test positivity rate was 2.3% (range, 0.0-27.4%). The mean conversion rate was 0.8% (range, 0.0-2.5%), and the mean reversion rate was 17.6%. Positivity and conversion rates correlated with known tuberculosis risk factors including age and sex. The observed specificity of the T-SPOT.TB test was at least 98.6%. Conclusions: The high concordance and test completion rates in this study suggest that the T-SPOT.TB test is a reliable tool for healthcare worker serial screening. As expected, the observed positivity rates were lower compared with the tuberculin skin test, likely reflecting the higher specificity of this test. Furthermore, the observed rates of conversion were low and significantly correlated with the geographic incidence of tuberculosis. Our findings suggest that the T-SPOT.TB test is an accurate and reliable way to screen healthcare workers.
AB - Rationale: Interferon-g release assays have significant advantages over tuberculin skin testing in many clinical situations. However, recent studies have called into question their reliability in serial testing of healthcare workers because of reportedly high rates of positivity and high conversion/reversion rates on retesting. Objectives: To define the performance characteristics of the T-SPOT.TBtest, an interferon-γ release assay, during serial screening programs of healthcare workers at 19 U.S. hospitals. Methods: A total of 42,155 T-SPOT.TB test results from healthcare workers at 19 geographically diverse hospitals obtained for routine tuberculosis screening programs were analyzed to determine the rates of positivity, reversion, and conversion in serial testing data. Measurements and Main Results: In 19,630 evaluable serial pairs from 16,076 healthcare workers, the mean test positivity rate was 2.3% (range, 0.0-27.4%). The mean conversion rate was 0.8% (range, 0.0-2.5%), and the mean reversion rate was 17.6%. Positivity and conversion rates correlated with known tuberculosis risk factors including age and sex. The observed specificity of the T-SPOT.TB test was at least 98.6%. Conclusions: The high concordance and test completion rates in this study suggest that the T-SPOT.TB test is a reliable tool for healthcare worker serial screening. As expected, the observed positivity rates were lower compared with the tuberculin skin test, likely reflecting the higher specificity of this test. Furthermore, the observed rates of conversion were low and significantly correlated with the geographic incidence of tuberculosis. Our findings suggest that the T-SPOT.TB test is an accurate and reliable way to screen healthcare workers.
KW - Conversion
KW - LTBI
KW - Reversion
KW - Serial testing
KW - Tuberculosis screening
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U2 - 10.1164/rccm.201501-0199OC
DO - 10.1164/rccm.201501-0199OC
M3 - Article
C2 - 26017193
AN - SCOPUS:84938899208
SN - 1073-449X
VL - 192
SP - 367
EP - 373
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 3
ER -