title: The effect of introducing IGRA to screen French healthcare workers for tuberculosis and potential conclusions for the work organisation.
abstract: BACKGROUND
  In France, pre-employment screening for tuberculosis (TB) is performed for healthcare workers (HCW). Screening is repeated when exposure to TB patients or infectious material occurs. The results of these TB screenings were analysed in a retrospective analysis.
  
  
  METHODS
  Tuberculin skin tests (TST) and interferon-gamma release assays (QuantiFERON® Gold In-Tube - QFT) were used to perform the TB screenings. The screening results of 637 HCWs on whom QFT was performed were taken from the records of the University Hospital of Nantes.
  
  
  RESULTS
  In three (0.5%) HCW, the QFT was indeterminate. In 22.2%, the QFT was positive. A second QFT was performed in 118 HCWs. The reversion rate was 42% (5 out of 17). The conversion rate was 6% (6 out of 98). A TST was performed on 466 (73.5%) of the HCWs. Results for TST > 10 mm were 77.4%. In those with a TST < 10 mm, QFT was positive in 14% and in those with a TST ≥ 10 mm, QFT was positive in 26.7%. Depending on the definition for conversion in the QFT, the annual attack rate was 4.1% or 7.3%. X-ray and pneumology consultation was based on positive QFT rather than TST alone (52 out of 56). No active TB was detected.
  
  
  CONCLUSIONS
  The TST overestimated the prevalence of LTBI in this cohort. The decision about X-ray and consultation regarding preventive treatment should be based on the QFT rather than the TST results. The high reversion rate should be taken into consideration when consulting with HCWs regarding preventive treatment. The high conversion rate seems to indicate that preventive measures such as wearing masks should be improved.
authors: Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, Nantes, France.
authors: Adrien
authors: A
authors: Moucaut
authors: Institute for Health Services Research in Dermatology and Nursing (IVDP), University Clinic Hamburg-Eppendorf, Hamburg, Germany ; Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services, Hamburg, Germany.
authors: Albert
authors: A
authors: Nienhaus
authors: Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, Nantes, France.
authors: Benedicte
authors: B
authors: Courtois
authors: Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, Nantes, France.
authors: Virginie
authors: V
authors: Nael
authors: Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, Nantes, France.
authors: Claire
authors: C
authors: Longuenesse
authors: Laboratory of Ergonomics and Epidemiology in Occupational Health, LEEST-UA InVS - IFR 132- UPRES EA 4336, University of Angers, Angers, France ; Faculty of Medicine Medicine E, University Hospital, 4 rue Larrey, Angers cedex, F 49933, France.
authors: Bruno
authors: B
authors: Ripault
authors: Laboratory of Ergonomics and Epidemiology in Occupational Health, LEEST-UA InVS - IFR 132- UPRES EA 4336, University of Angers, Angers, France ; Faculty of Medicine Medicine E, University Hospital, 4 rue Larrey, Angers cedex, F 49933, France.
authors: Pierre
authors: P
authors: Rucay
authors: Laboratory of Ergonomics and Epidemiology in Occupational Health, LEEST-UA InVS - IFR 132- UPRES EA 4336, University of Angers, Angers, France ; Faculty of Medicine Medicine E, University Hospital, 4 rue Larrey, Angers cedex, F 49933, France.
authors: Stéphanie
authors: S
authors: Moisan
authors: Laboratory of Ergonomics and Epidemiology in Occupational Health, LEEST-UA InVS - IFR 132- UPRES EA 4336, University of Angers, Angers, France ; Faculty of Medicine Medicine E, University Hospital, 4 rue Larrey, Angers cedex, F 49933, France.
authors: Yves
authors: Y
authors: Roquelaure
authors: Department of Occupational Medicine and Occupational Hazards, University Hospital of Nantes, Nantes, France ; Laboratory of Ergonomics and Epidemiology in Occupational Health, LEEST-UA InVS - IFR 132- UPRES EA 4336, University of Angers, Angers, France ; Faculty of Medicine Medicine E, University Hospital, 4 rue Larrey, Angers cedex, F 49933, France.
authors: Dominique
authors: D
authors: Tripodi
keywords: Healthcare workers; Interferon-gamma release assay; Tuberculosis
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