Tuberc Respir Dis.  2015 Oct;78(4):349-355. 10.4046/trd.2015.78.4.349.

The Prevalence Rate of Tuberculin Skin Test Positive by Contacts Group to Predict the Development of Active Tuberculosis After School Outbreaks

Affiliations
  • 1Korean Institute of Tuberculosis, Cheongwon, Korea.
  • 2Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
  • 3SRC, Department of Statistics, Seoul National University, Seoul, Korea.
  • 4Health Insurance Review and Assessment Service, Seoul, Korea.
  • 5Public Healthcare Center, Ansan, Korea.
  • 6Division of Pulmonary, Sleep, and Critical Care Medicine, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea. lee-sh@korea.ac.kr

Abstract

BACKGROUND
The tuberculin skin test (TST) is the standard tool to diagnose latent tuberculosis infection (LTBI) in mass screening. The aim of this study is to find an optimal cut-off point of the TST+ rate within tuberculosis (TB) contacts to predict the active TB development among adolescents in school TB outbreaks.
METHODS
The Korean National Health Insurance Review and Assessment database was used to identify active TB development in relation to the initial TST (cut-off, 10 mm). The 7,475 contacts in 89 schools were divided into two groups: Incident TB group (43 schools) and no incident TB group (46 schools). LTBI treatment was initiated in 607 of the 1,761 TST+ contacts. The association with active TB progression was examined at different cut-off points of the TST+ rate.
RESULTS
The mean duration of follow-up was 3.9+/-0.9 years. Thirty-three contacts developed active TB during the 4,504 person-years among the TST+ contacts without LTBI treatment (n=1,154). The average TST+ rate for the incident TB group (n=43) and no incident TB group (n=46) were 31.0% and 15.5%, respectively. The TST+ rate per group was related with TB progression (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.001-1.050; p=0.037). Based on the TST+ rate per group, active TB was best predicted at TST+ > or = 16% (OR, 3.11; 95% CI, 1.29-7.51; area under curve, 0.64).
CONCLUSION
Sixteen percent of the TST+ rate per group within the same grade students can be suggested as an optimal cut-off to predict active TB development in middle and high schools TB outbreaks.

Keyword

Adolescent; Disease Outbreaks; Tuberculin Test; Latent Tuberculosis; Tuberculosis

MeSH Terms

Adolescent
Area Under Curve
Disease Outbreaks*
Follow-Up Studies
Humans
Latent Tuberculosis
Mass Screening
National Health Programs
Prevalence*
Skin Tests*
Skin*
Tuberculin Test
Tuberculin*
Tuberculosis*
Tuberculin

Figure

  • Figure 1 Flow diagram for TB contacts of infectious patients with tuberculosis. TB: tuberculosis; TST: tuberculin skin test; LTBI: latent tuberculosis infection.


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