Challenges of interferon-γ release assay conversions in serial testing of health-care workers in a TB control program.
BACKGROUND
Clinical data with use of serial interferon-γ release assay (IGRA) testing in US health-care workers (HCWs) are limited.


METHODS
A single-center, retrospective chart review was done from 2007 to 2010 of HCWs who underwent preemployment QuantiFERON-TB Gold In-Tube testing. Demographic data, bacille Calmette-Guérin history, prior tuberculin skin test result if done, and baseline and serial IGRA values were obtained. The number of IGRA converters and reverters and their subsequent management by infectious disease physicians were reviewed. Quantitative IGRA-negative values were not available.


RESULTS
A total of 7,374 IGRAs were performed on newly hired HCWs. Of these tests, 486 (6.6%) were positive at baseline, 305 (4.1%) were indeterminate, and 6,583 (89.3%) were negative. From 2007 to 2010, 52 of 1,857 HCWs (2.8%) with serial IGRA tests were identified as converters, with a serial IGRA median value of 0.63 IU/mL. Seventy-one percent of HCWs with IGRA conversion had values ≤ 1 IU/mL. None of the converters had active TB or were part of an outbreak investigation.


CONCLUSIONS
Clinical significance of most QuantiFERON-TB Gold In-Tube conversions in serial testing remains a challenging task for clinicians. The use of a single cutoff point criterion for IGRA may lead to overdiagnosis of new TB infections. Clinical assessment and evaluation may help to prevent unnecessary therapy in these cases. The criteria for defining conversions and reversions by establishing new cutoffs needs to be evaluated further, especially in HCWs.
Department of Infectious Disease, Cleveland Clinic, Cleveland, OH. Electronic address: fongk2@ccf.org.
Kimberlee S
KS
Fong
Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
J Walton
JW
Tomford
Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
Lucileia
L
Teixeira
Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
Thomas G
TG
Fraser
Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
David
D
van Duin
Department of Pathology, Cleveland Clinic, Cleveland, OH.
Belinda
B
Yen-Lieberman
Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
Steve M
SM
Gordon
Department of Infectious Disease, Cleveland Clinic, Cleveland, OH.
Cyndee
C
Miranda
D000293:Adolescent; D000328:Adult; D005260:Female; D006282:Health Personnel; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D059425:Interferon-gamma Release Tests / Q000592:standards*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult