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Abstract

Background

Tuberculosis (TB) elimination requires identifying and treating persons with TB infection (TBI).

Aim

We estimate the prevalence of positive interferon gamma release assay (IGRA) tests (including TB) and TBI (excluding TB) in Denmark based on TBI screening data from patients with inflammatory bowel disease (IBD) or inflammatory rheumatic disease (IRD).

Methods

Using nationwide Danish registries, we included all patients with IBD or IRD with an IGRA test performed between 2010 and 2018. We estimated the prevalence of TBI and positive IGRA with 95% confidence intervals (CI) in adolescents and adults aged 15–64 years after sample weighting adjusting for distortions in the sample from the background population of Denmark for sex, age group and TB incidence rates (IR) in country of birth.

Results

In 13,574 patients with IBD or IRD, 12,892 IGRA tests (95.0%) were negative, 461 (3.4%) were positive and 221 (1.6%) were indeterminate, resulting in a weighted TBI prevalence of 3.2% (95% CI: 2.9–3.5) and weighted positive IGRA prevalence of 3.8% (95% CI: 3.5–4.2) among adults aged 15–64 years in the background population of Denmark. Unweighted TBI prevalence increased with age and birthplace in countries with a TB IR higher than 10/100,000 population.

Conclusion

Estimated TBI prevalence is low in Denmark. We estimate that 200,000 persons have TBI and thus are at risk of developing TB. Screening for TBI and preventive treatment, especially in persons born in high TB incidence countries or immunosuppressed, are crucial to reduce the risk of and eliminate TB.

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/content/10.2807/1560-7917.ES.2024.29.12.2300590
2024-03-21
2024-04-20
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2024.29.12.2300590
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References

  1. World Health Organization (WHO). Towards tuberculosis elimination: an action framework for low-incidence countries. Geneva: WHO; 2014. Available from: https://www.who.int/publications/i/item/9789241507707
  2. Kristensen KL, Ravn P, Petersen JH, Hargreaves S, Nellums LB, Friedland JS, et al. Long-term risk of tuberculosis among migrants according to migrant status: a cohort study. Int J Epidemiol. 2020;49(3):776-85.  https://doi.org/10.1093/ije/dyaa063 
  3. Gupta RK, Calderwood CJ, Yavlinsky A, Krutikov M, Quartagno M, Aichelburg MC, et al. Discovery and validation of a personalized risk predictor for incident tuberculosis in low transmission settings. Nat Med. 2020;26(12):1941-9.  https://doi.org/10.1038/s41591-020-1076-0 
  4. Houben RM, Dodd PJ. The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling. PLoS Med. 2016;13(10):e1002152.  https://doi.org/10.1371/journal.pmed.1002152 
  5. European Centre for Disease Prevention and Control (ECDC) and World Health Organization. (WHO) Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2023 – 2021 data. Stockholm: ECDC; 2023. Available from: https://www.ecdc.europa.eu/en/publications-data/tuberculosis-surveillance-and-monitoring-europe-2023-2021-data
  6. Statens Serum Institut (SSI). Tuberculosis 2021. Copenhagen: SSI; 2021. [Accessed: 15 Feb 2024]. Available from: https://en.ssi.dk/surveillance-and-preparedness/surveillance-in-denmark/annual-reports-on-disease-incidence/tuberculosis-2021
  7. Cohen A, Mathiasen VD, Schön T, Wejse C. The global prevalence of latent tuberculosis: a systematic review and meta-analysis. Eur Respir J. 2019;54(3):1900655.  https://doi.org/10.1183/13993003.00655-2019 
  8. Stærke NB, Hilberg O, Wejse C, Hoffmann HJ, Fløe A. Latent tuberculosis infection is prevalent among socially marginalised citizens in Aarhus, Denmark. Dan Med J. 2016;63(7):A5249. Available from: https://ugeskriftet.dk/dmj/latent-tuberculosis-infection-prevalent-among-socially-marginalised-citizens-aarhus-denmark
  9. Stærke NB, Fløe A, Nielsen MF, Holm M, Holm E, Hilberg O, et al. The cascade of care in tuberculosis infection screening and management in newly arrived refugees in Aarhus, Denmark. Travel Med Infect Dis. 2022;49:102388.  https://doi.org/10.1016/j.tmaid.2022.102388 
  10. Singh JA, Wells GA, Christensen R, Tanjong Ghogomu E, Maxwell L, Macdonald JK, et al. Adverse effects of biologics: a network meta-analysis and Cochrane overview. Cochrane Libr. 2011;2011(2):CD008794.  https://doi.org/10.1002/14651858.CD008794.pub2 
  11. Jensen-Fangel S, Helweg-Larsen J, Fløe Hvass A, Graff Jensen S, Kolte L, Larsen L, et al. Tuberkuloseinfektion hos personer, som skal i immunsupprimerende behandling. Rekommandationer for udredning og behandling. [Tuberculosis infection in persons undergoing immunosuppressive treatment. Recommendations for investigation and treatment]. Dansk Selskab for Infektionsmedicin og Dansk Lungemedicinsk Selskab; 2023. Danish. Available from: https://lungemedicin.dk/wp-content/uploads/2021/05/DSI-og-DLS-Tuberkuloseinfektion-hos-immunsupprimerede-udredning-og-behandling-240223.pdf
  12. Bélard E, Semb S, Ruhwald M, Werlinrud AM, Soborg B, Jensen FK, et al. Prednisolone treatment affects the performance of the QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection. Inflamm Bowel Dis. 2011;17(11):2340-9.  https://doi.org/10.1002/ibd.21605 
  13. Schmidt M, Schmidt SA, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015;7:449-90.  https://doi.org/10.2147/CLEP.S91125 
  14. Schmidt M, Pedersen L, Sørensen HT. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol. 2014;29(8):541-9.  https://doi.org/10.1007/s10654-014-9930-3 
  15. Qiagen. 2016. QuantiFERON-TB Gold Plus (QFT-Plus) ELISA package insert—the whole blood IFN-γ test measuring responses to ESAT-6 and CFP-10 peptide antigens. 1083163 Rev. 04. Qiagen, Valencia, CA. [Accessed: 6 Jul 2024]. Available from: https://www.qiagen.com/us/resources/download.aspx?id=ac068fc7-a994-4443-ac7c-dda43ce2bc5e&lang=en
  16. Statistics Denmark. Population 1. January by day of birth, birth month and year of birth. [Accessed: 5 Jun 2023]. Available from: https://www.statbank.dk/BEFOLK2
  17. Solon G, Haider SJ, Wooldridge JM. What Are We Weighting For? J Hum Resour. 2015;50(2):301-16.  https://doi.org/10.3368/jhr.50.2.301 
  18. Vega V, Rodríguez S, Van der Stuyft P, Seas C, Otero L. Recurrent TB: a systematic review and meta-analysis of the incidence rates and the proportions of relapses and reinfections. Thorax. 2021;76(5):494-502.  https://doi.org/10.1136/thoraxjnl-2020-215449 
  19. United Nations Department of Economic and Social Affairs. World Population Prospects. New York: United Nations 2022. Available from: https://population.un.org/wpp/Graphs/DemographicProfiles/Line/900
  20. World Health Organization (WHO). Global tuberculosis report 2020. Geneva: WHO; 2020. [Accessed: 27 Nov 2023]. Available from: https://www.who.int/publications/i/item/9789240013131
  21. Holden IK, Lillebaek T, Andersen PH, Wejse C, Johansen IS. Characteristics and predictors for tuberculosis related mortality in Denmark from 2009 through 2014: A retrospective cohort study. PLoS One. 2020;15(6):e0231821.  https://doi.org/10.1371/journal.pone.0231821 
  22. Piergallini TJ, Turner J. Tuberculosis in the elderly: why inflammation matters. Exp Gerontol. 2018;105:32-9.  https://doi.org/10.1016/j.exger.2017.12.021 
  23. Behr MA, Edelstein PH, Ramakrishnan L. Revisiting the timetable of tuberculosis. BMJ. 2018;362:k2738.  https://doi.org/10.1136/bmj.k2738 
  24. Dale KD, Karmakar M, Snow KJ, Menzies D, Trauer JM, Denholm JT. Quantifying the rates of late reactivation tuberculosis: a systematic review. Lancet Infect Dis. 2021;21(10):e303-17.  https://doi.org/10.1016/S1473-3099(20)30728-3 
  25. Danish Health and Medicines Authority. Vejledning om forebyggelse af tuberkulose. [Guideline on tuberculosis prevention]. 2015. [Accessed: 2 Aug 2024]. Danish. Available from: https://www.sst.dk/-/media/Udgivelser/2015/Vejledning-om-forebyggelse-af-tuberkulose-endelig-version.ashx?la=da&hx0026;hash=21C1C19295119AD81FC441CFAD18EB185811DC1F
  26. Ahmad BB, Kristensen KL, Glenthoej JP, Poulsen A, Bryld AG, Huber FG, et al. Latent tuberculosis infection among minor asylum seekers in Denmark. Eur Respir J. 2020;55(1):1901688.  https://doi.org/10.1183/13993003.01688-2019 
  27. Spruijt I, Joren C, van den Hof S, Erkens C. Tailored approaches facilitate high completion of tuberculosis infection treatment among migrants. Eur Respir J. 2022;59(3):2102077.  https://doi.org/10.1183/13993003.02077-2021 
  28. Dale KD, Trauer JM, Dodd PJ, Houben RMGJ, Denholm JT. Estimating the prevalence of latent tuberculosis in a low-incidence setting: Australia. Eur Respir J. 2018;52(6):1801218.  https://doi.org/10.1183/13993003.01218-2018 
  29. Mancuso JD, Diffenderfer JM, Ghassemieh BJ, Horne DJ, Kao TC. The prevalence of latent tuberculosis infection in the United States. Am J Respir Crit Care Med. 2016;194(4):501-9.  https://doi.org/10.1164/rccm.201508-1683OC 
  30. World Health Organization (WHO). Global tuberculosis report 2013. Geneva: WHO; 2013. [Accessed: 22 Dec 2023]. Available from: https://www.who.int/publications/i/item/9789241564656
  31. Yang Y, Wang HJ, Hu WL, Bai GN, Hua CZ. Diagnostic value of interferon-gamma release assays for tuberculosis in the immunocompromised population. Diagnostics (Basel). 2022;12(2):453.  https://doi.org/10.3390/diagnostics12020453 
  32. Mirzazadeh A, Kahn JG, Haddad MB, Hill AN, Marks SM, Readhead A, et al. State-level prevalence estimates of latent tuberculosis infection in the United States by medical risk factors, demographic characteristics and nativity. PloS One. 2021;16(4):e0249012-e.  https://doi.org/10.1371/journal.pone.0249012 
  33. United Nations Department of Economic and Social Affairs Population Division. World population prospects 2022. [Accessed: 9 Aug 2023]. Available from: https://population.un.org/wpp/Graphs/DemographicProfiles/Line/900
  34. Zhou G, Luo Q, Luo S, Chen H, Cai S, Guo X, et al. Indeterminate results of interferon gamma release assays in the screening of latent tuberculosis infection: a systematic review and meta-analysis. Front Immunol. 2023;14:1170579.  https://doi.org/10.3389/fimmu.2023.1170579 
  35. Hermansen TS, Lillebaek T, Langholz Kristensen K, Andersen PH, Ravn P. Prognostic value of interferon-γ release assays, a population-based study from a TB low-incidence country. Thorax. 2016;71(7):652-8.  https://doi.org/10.1136/thoraxjnl-2015-208228 
  36. Sester M, van Leth F, Bruchfeld J, Bumbacea D, Cirillo DM, Dilektasli AG, et al. TBNET. Risk assessment of tuberculosis in immunocompromised patients. A TBNET study. Am J Respir Crit Care Med. 2014;190(10):1168-76.  https://doi.org/10.1164/rccm.201405-0967OC 
  37. Pai M, Denkinger CM, Kik SV, Rangaka MX, Zwerling A, Oxlade O, et al. Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev. 2014;27(1):3-20.  https://doi.org/10.1128/CMR.00034-13 
  38. Chiacchio T, Petruccioli E, Vanini V, Cuzzi G, Massafra U, Baldi G, et al. Characterization of QuantiFERON-TB-Plus results in latent tuberculosis infected patients with or without immune-mediated inflammatory diseases. J Infect. 2019;79(1):15-23.  https://doi.org/10.1016/j.jinf.2019.04.010 
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