Trajectories of tuberculosis-specific interferon-gamma release assay responses among medical and nursing students in rural India

Alice Zwerling; Rajnish Joshi; S.P. Kalantri; Gajalakshmi Dakshinamoorthy; Maryada Venkatarama Reddy; Andrea Benedetti; Kevin Schwartzman; Dick Menzies; Madhukar Pai

doi:10.1016/j.jegh.2013.03.003

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Volume 3, Issue 2, June 2013, Pages 105 - 117

Trajectories of tuberculosis-specific interferon-gamma release assay responses among medical and nursing students in rural India

Authors

Alice Zwerling^a^{, e}, Rajnish Joshi^b, S.P. Kalantri^c, Gajalakshmi Dakshinamoorthy^d, Maryada Venkatarama Reddy^d, Andrea Benedetti^a^{, e}^{, f}, Kevin Schwartzman^a^{, e}^{, f}, Dick Menzies^a^{, e}^{, f}, Madhukar Pai^a^{, e}^{, *}^,madhukar.pai@mcgill.ca

^aDepartment of Epidemiology and Biostatistics, McGill University, Montreal, Canada

^bSikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim

^cDepartment of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India

^dDepartment of Biochemistry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India

^eRespiratory Epidemiology & Clinical Research Unit, Montreal Chest Institute, Montreal, Canada

^fDepartment of Medicine, McGill University, Montreal, Canada

^*Corresponding author. Address: McGill University, Department of Epidemiology and Biostatistics, 1020 Pine Ave. West, Montreal, QC, Canada H3A 1A2. Tel.: +1 514 398 5422; fax: +1 514 398 4503.

Corresponding Author

Madhukar Paimadhukar.pai@mcgill.ca

Received 15 December 2012, Revised 7 March 2013, Accepted 12 March 2013, Available Online 10 April 2013.

DOI: 10.1016/j.jegh.2013.03.003 How to use a DOI?
Keywords: TB screening; LTBI; Serial testing; Health care workers
Abstract: Background: Interferon gamma release assays (IGRAs) have been shown to be highly dynamic tests when used in serial testing for TB infection. However, there is little information demonstrating a clear association between TB exposure and IGRA responses over time, particularly in high TB incidence settings.

Objectives: To assess whether QuantiFERON-TB Gold In-Tube (QFT) responses are associated with occupational TB exposures in a cohort of young health care trainees in India.

Methods: All medical and nursing students at Mahatma Gandhi Institute of Medical Sciences were approached. Participants were followed up for 18 months; QFT was performed 4 times, once every 6 months. Various modeling approaches were used to define IFN-gamma trajectories and correlations with TB exposure.

Results: Among 270 medical and nursing trainees, high rates of conversions (6.3–20.9%) and reversions (20.0–26.2%) were found depending on the definitions used. Stable converters were more likely to have had TB exposure in hospital pre-study. Recent occupational exposures were not consistently associated with QFT responses over time.

Conclusion: IFN-gamma responses and rates of change could not be explained by occupational exposure investigated. High conversion and subsequent reversion rates suggest many health care workers (HCWs) would revert in the absence of treatment, either by clearing the infection naturally or due to fluctuations in the underlying immunological response and/or poor assay reproducibility. QFT may not be an ideal diagnostic test for repeated screening of HCWs in a high TB incidence setting.
Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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<Previous Article In Issue

Journal: Journal of Epidemiology and Global Health
Volume-Issue: 3 - 2
Pages: 105 - 117
Publication Date: 2013/04/10
ISSN (Online): 2210-6014
ISSN (Print): 2210-6006
DOI: 10.1016/j.jegh.2013.03.003 How to use a DOI?
Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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ris enw bib

TY  - JOUR
AU  - Alice Zwerling
AU  - Rajnish Joshi
AU  - S.P. Kalantri
AU  - Gajalakshmi Dakshinamoorthy
AU  - Maryada Venkatarama Reddy
AU  - Andrea Benedetti
AU  - Kevin Schwartzman
AU  - Dick Menzies
AU  - Madhukar Pai
PY  - 2013
DA  - 2013/04/10
TI  - Trajectories of tuberculosis-specific interferon-gamma release assay responses among medical and nursing students in rural India
JO  - Journal of Epidemiology and Global Health
SP  - 105
EP  - 117
VL  - 3
IS  - 2
SN  - 2210-6014
UR  - https://doi.org/10.1016/j.jegh.2013.03.003
DO  - 10.1016/j.jegh.2013.03.003
ID  - Zwerling2013
ER  -

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