1649. Tuberculosis Screening of International Students in Arkansas: Era of Interferon Gamma Release Assay
Session: Poster Abstract Session: Mycobacterial Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Tuberculosis screening students poster.png (345.3 kB)
  • Background:

     Arkansas introduced a regulation for tuberculosis (TB) screening of international students from TB endemic countries in 2004. There are 33 institutions covered by this regulation. Since 2004, 13 TB cases have been reported among international students, and only 2 had violated the screening regulation. No US-born students have developed TB.   The tuberculin skin test (TST) has recently been replaced by interferon gamma release assay (IGRA) in the majority of institutions.  Also, treatment of LTBI is now increasingly done using the 12-dose, once weekly isoniazid/rifapentine (3HP) regimen instead of the traditional 9-months of daily isoniazid (INH) regimen. In this report, we will describe the TB screening experience of the Flagship University in the state; comparing latent tuberculosis infection (LTBI) rates before and after introduction of IGRA, specifically T-SPOT.TB.

    Methods:

    Tuberculosis screening is performed on students from TB endemic countries within the first 60 days of matriculation at Arkansas colleges.  Screening data are captured in a Web-enabled database, which is hosted by the TB Control Program, and is accessible to student health personnel in the various institutions. During academic years 2008-09, and 2009-10, TST was used for TB screening. In the subsequent academic years, 2010-12, and 2011-13, T-SPOT.TB was the screening method.

    Results:

    The table below summarizes the TB screening experience of the Flagship University in Arkansas, before and after deployment of T-SPOT.TBas the screening test.  

    Academic Years

    Screening Method

    Students Screened

    LTBI (%)

    Rate Ratio

    2008-2010

    TST

    505

    292 (57.8)

    9.2

    2011-2013

    T-SPOT

    1465

    93 (6.3)

    1.0

    Conclusion:

    The data suggest that for every one case diagnosed with LTBI using T-SPOT.TB there are as many as 9.2 cases of LTBI if TST were used. This has important implications in terms of the cost of unnecessary follow-up chest x-ray and associated radiation exposure, plus 9 months of isoniazid treatment and associated risk of hepatotoxicity on a potentially significant false positive group. It is recommended that institutions consider switching from TST to IGRA.

    Naveen Patil, MD MHSA MA1, Lyn Edington, RNC2, Huda Sharaf, MD2, Xiaoyan Egbe, BBA3, Dusti Murphy, RN4 and Leonard Mukasa, MBChB PhD5, (1)TB, HIV, STD, Hepatitis, Arkansas Department of Health, Little Rock, AR, (2)Pat Walker Health Center, University of Arkansas, Fayetteville, AR, (3)TB, Arkansas Department of Health, Little Rock, AR, (4)Communicable Diseases, Arkansas Department of Health, Fayetteville, AR, (5)Tuberculosis Control Program, Arkansas Department of Health, Little Rock, AR

    Disclosures:

    N. Patil, None

    L. Edington, None

    H. Sharaf, None

    X. Egbe, None

    D. Murphy, None

    L. Mukasa, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.