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Journal of Occupational Medicine and Toxicology
Published in: Journal of Occupational Medicine and Toxicology 1/2012

Open Access 01-12-2012 | Research

Interferon-gamma release assays for the tuberculosis serial testing of health care workers: a systematic review

Authors: Felix C Ringshausen, Anja Schablon, Albert Nienhaus

Published in: Journal of Occupational Medicine and Toxicology | Issue 1/2012

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Abstract

Background

Interferon-gamma release assays (IGRAs) are increasingly used in the tuberculosis (TB) screening of health care workers (HCWs). However, comparatively high rates of conversions and reversion as well as growing evidence of substantial within-subject variability of interferon-gamma responses complicate their interpretation in the serial testing of HCWs.

Methods

We conducted a systematic review on the repeat use of the two commercial IGRAs, the QuantiFERON-TB Gold or In-Tube version (QFT) and the T-SPOT.TB (T-SPOT), in the serial testing and its with-subject variability among HCWs in order to provide guidance on how to interpret serial testing results in the context of the periodic screening of subjects with an increased occupational risk of latent TB infection (LTBI) in countries with low and intermediate TB incidence rates. The Medline, Embase, and Cochrane databases were searched without restrictions. Retrieved articles were complemented by additional hand searched records. Only studies that used commercial IGRAs among HCWs apart from contact and outbreak investigations and those fulfilling further predefined criteria were included.

Results

Overall, 20 studies, five using the T-SPOT and 19 using the QFT assay, were included. Fifteen studies met eligibility criteria for serial testing and five studies for within-subject variability. Irrespective of TB incidence rates in the study’s country of origin, reversion rates were consistently higher than conversion rates (range 22–71% vs. 1–14%). Subjects with baseline results around the diagnostic threshold were more likely to show inconsistent results on retesting. The within-subject variability of interferon-gamma responses was considerable across all studies systematically assessing it.

Conclusions

On the basis of reviewed studies we advocate using a borderline zone from 0.2–0.7 IU/ml for the interpretation of repeat QFT results in the routine screening of HCWs with an increased LTBI risk. Subjects with QFT results within this borderline zone, with suspected fresh infection, and those who are considered for preventive chemotherapy should be retested with the QFT within a period of about four weeks before preventive chemotherapy is recommended. However, the available data regarding the use of the T-SPOT in the serial testing of HCWs is remarkably limited and warrants further research.
Appendix
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Metadata
Title
Interferon-gamma release assays for the tuberculosis serial testing of health care workers: a systematic review
Authors
Felix C Ringshausen
Anja Schablon
Albert Nienhaus
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Journal of Occupational Medicine and Toxicology / Issue 1/2012
Electronic ISSN: 1745-6673
DOI
https://doi.org/10.1186/1745-6673-7-6

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