Immunosurveillance for Mycobacterium tuberculosis of health care personnel in a third level care hospital.
Immunosurveillance for Mycobacterium tuberculosis of health care personnel in a third level care hospital.
复制标题
三级甲等医院医护人员结核杆菌免疫监测。
DOI：
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
H. Huemer
中科院分区：
文献类型：
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作者：
C. Larcher;E. Frizzera;P. Pretto;M. Lang;Nora Sonnleitner;H. Huemer
背景
卫生保健工作者面临结核分枝杆菌（MTB）感染的风险。
目标
在结核病监测覆盖的800张床位的三级护理医院的621名员工中进行职业健康调查。
方法
对结核菌素皮肤试验（TST）、QuantiFERON-TB Gold试管法（QFT）、血清抗体PPD-ELISA和职业或疫苗数据的结果进行统计分析。
结果
29.1%的受试者TST阳性，18.5%的受试者QFT阳性。在23%的受试者中，未发现这些测试之间的相关性，推测与BCG疫苗接种有关，因为接种疫苗的受试者中TST阳性率高4倍，而未接种疫苗的受试者中两种测试相关性良好。QFT值大于2 IU/ml与TST阳性和年龄大于40岁显著相关。在MTB风险等级4工作与QFT、TST和PPD抗体水平显著相关，表明重复暴露的增强效应。没有观察到明显的相关性与医学专业，但显着较高的QFT阳性被发现在受试者没有分配到经典的医疗专业和来自结核病的高风险地区。
结论
这些结果将重点转移到维修人员身上，他们大多在MTB风险等级2的区域工作。在接种疫苗的受试者中，QFT的阳性结果较少，这突出了QFT作为筛查工具的优势，并为BCG疫苗的保护作用辩护，尽管接种疫苗的人的百分比在不同的医学专业之间存在很大差异。有趣的是，报告MTB暴露的受试者中QFT阳性者的百分比低于不知道暴露事件的受试者。
BACKGROUND
Health care workers are at risk for Mycobacterium tuberculosis (MTB) infection.
OBJECTIVES
To perform an occupational health survey among 621 employees of a 800-bed third level care hospital covered by MTB surveillance.
METHODS
Statistical analysis was applied to results from tuberculin skin test (TST), QuantiFERON - TB Gold in tube assay (QFT), PPD-ELISA for serum antibodies, and occupational or vaccine data.
RESULTS
29.1% of subjects were TST positive, 18.5% were QFT positive. In 23% of subjects no correlation between these tests was found, presumably linked to BCG-vaccination, since TST positivity was 4 times higher among vaccinated subjects, whereas both tests correlated well in unvaccinated subjects. QFT values above 2 IU/ml were significantly associated with positive TST and age over 40 years. Working in MTB risk level 4 was significantly associated with QFT, TST and PPD-antibody levels, suggesting booster effects by repeated exposure. No clear correlation was observed with medical specializations but significantly higher QFTpositivity was found in subjects not assigned to the classical medical professions and originating from MTB high risk areas.
CONCLUSIONS
These results shift the focus on maintenance personnel, who mostly worked in MTB risk level 2 areas. The less positive QFT results in vaccinated subjects highlight QFT's advantage as a screening tool and argue for a protective effect of the BCG-vaccine, although percentages of vaccinated persons varied largely between different medical professions. Interestingly, the percentage of QFT positive persons was lower among subjects reporting MTB exposure than those who were not aware of exposure events.