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Interferon-γ releasing assay versus tuberculin skin testing for latent tuberculosis infection in targeted screening programs for high risk immigrants

  • Clinical and Epidemiological Study
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Abstract

Background

Recent immigrants from developing countries (<2 years since immigration) are at very high risk of active TB disease due to reactivation of latent infections acquired in the country of origin. In industrialized low-incidence TB countries targeted testing programs for high risk groups could allow the detection of latently infected persons who would likely benefit from a course of preventive treatment. In this study we evaluated the tuberculin skin test (TST) and interferon-γ enzyme-linked immunosorbent assay (QuantiFERON TB-gold in tube, QFT-IT) strategies for TB infection screening programs in recent immigrants from highly endemic countries.

Patients and methods

This is a prospective cross-sectional study. Paired tests performed in 1,130 immigrants attending an outpatient ward, between 2005 and 2007 for any health problem were evaluated by intention-to-treat (ITT) and per-protocol (PP) analysis for efficiency and efficacy of screening program.

Results

Positive TST and QFT-IT were observed in 36.04 versus 29.82% (ITT) and in 45.27 versus 30.22% (PP) respectively. A higher drop-out rate was observed for TST (20.35 vs. 1.33%) (p < 0.0001). Second level assessment was accepted by half of the TST positive patients. Overall agreement rate between 887 paired tests was fair (k = 0.38). Higher k values were observed for higher TB prevalence rate in the country of origin (k = 0.43), for TST induration diameters >20 mM (k = 0.47), in subjects aged 40–50 years (k = 0.41) and in unvaccinated persons (k = 0.40). In a multiple logistic regression model continent of origin, class of TB prevalence in the country of origin and contacts with TB patients were found to be significantly associated with the probability of TST and QFT-IT positive result. Low education levels were associated only to an increased risk of TST positive results.

Conclusions

The drawback of the TST screening strategy in recent immigrants from highly endemic countries is due to low sensitivity/specificity of the test and to high drop-out rate with an overall significant lowering in strategy efficacy/efficiency. The higher QFT-IT specificity prevents unnecessary overload of the health care system and, although more expensive, might represent a cost-effective alternative to TST in targeted screening programs directed to high risk populations.

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Acknowledgments

The authors acknowledge the Provincia di Milano, Assessorato alle Politiche Sociali for the financial support of the study.

Conflict of interest statement

None.

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Authors and Affiliations

  1. II Division Infectious Diseases, Infectious Diseases Department, L Sacco University Hospital, Via GB Grassi, 74, 20157, Milan, Italy

    G. Orlando, S. Merli, L. Cordier & F. Mazza

  2. Institute for Medical Statistics and Biometry, University of Milan, Milan, Italy

    G. Casazza

  3. Opera San Francesco Outpatient Ward, Milan, Italy

    A. M. Villa

  4. Institute “Villa Marelli”, Niguarda Ca’ Granda Hospital, Milan, Italy

    L. Codecasa & M. Ferrarese

  5. Division of Infectious Diseases, Hospital Parma, Parma, Italy

    E. Negri

  6. Fondazione AIDS-Aiuto, Aids-Aid, Milan, Italy

    A. Cargnel

  7. I and II Division Infectious Diseases, L Sacco University Hospital, Milan, Italy

    G. Rizzardini

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  1. G. Orlando
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  4. F. Mazza
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Correspondence to G. Orlando.

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Orlando, G., Merli, S., Cordier, L. et al. Interferon-γ releasing assay versus tuberculin skin testing for latent tuberculosis infection in targeted screening programs for high risk immigrants. Infection 38, 195–204 (2010). https://doi.org/10.1007/s15010-010-0015-2

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  • DOI: https://doi.org/10.1007/s15010-010-0015-2

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