Serial testing of health care workers for tuberculosis infection: A prospective cohort study.

Health Care Workers (HCW) may have an occupational risk of latent tuberculosis infection (LTBI) and TB disease. The objective of this study was to evaluate the performance of the 2-step strategy: tuberculin skin test (TST) followed by confirmation with Interferon (IFN)-γ- release assays (IGRAs) in HCW. A secondary objective was to determine the factors related to conversions and reversions. HCW at risk of occupational exposure who attended the Occupational Department of the Hospital Germans Trias i Pujol were included during the study period (2013-2016). All professionals testing negative for LTBI were included in a cohort study. These workers were followed up with the administration of a TST and an IGRA quantification at least one year after inclusion in the study. Workers with positive TST, regardless of the results of the IGRA tests, were followed-up with an IGRA. 255 workers were enrolled in the study and 108 workers from the same cohort were followed up. During the follow-up period, seven workers presented TST test conversion. One of these conversions was also confirmed by an IGRA test. There were 2 conversions of cases only testing positive with the IGRA. There have been only 2 reversions of cases testing negative with the IGRA. In this study, not all TST conversions were confirmed when using the IGRA test, which highlights the importance of the 2-step strategy. We have detected a low number of conversions and reversions. Our conclusions should be confirmed in studies with a longer follow-up time.

[HOSPITALS AS PROMOTERS OF SMOKELESS SPACES: STRATEGIES AIMED AT SMOKING CONTROL] / El hospital como centro promotor de espacios sin humo: estrategias dirigidas al control del tabaquismo.

The objective of this study was to describe the measures introduced at the Hospital Germans Trias i Pujol, Barcelona, aimed at achieving a smoke-free environment, and encouraging research, training, and clinical approaches with respect to smoking. The experience gained as a center attached to the Catalan Network of Smokeless Hospitals since 2002 shows that preventing and controlling smoking requires a specific agenda developed by a competent committee comprising workers from all hospital areas. Likewise, coordination with other centers in the network is essential as it permits the sharing of experiences. The involvement of hospital management is critical for the effective introduction of health protection and promotion strategies, both in workers and in users. The raising of awareness and the ongoing training of all health workers and coordination with other health care providers in the Health network are the main aspects that require strengthening in the future.

El objetivo de este trabajo fue describir las medidas llevadas a cabo en el Hospital Germans Trias i Pujol de Barcelona, destinadas a conseguir un entorno libre de humo, así como al desarrollo de actividades de investigación, formación y abordaje clínico en relación al tabaquismo. La experiencia como centro adherido a la Red Catalana de Hospitales Sin Humo desde 2002 nos revela que para la prevención y control del tabaquismo es necesaria una agenda específica desarrollada por un Comité competente, compuesto por trabajadores de diferentes estamentos y servicios del centro. Del mismo modo, consideramos fundamental la coordinación con otros centros de la Red que permita compartir experiencias, así como la implicación de la Dirección del Centro para la implementación efectiva de las estrategias de promoción y protección de la salud, tanto en los trabajadores como en los usuarios. La sensibilización y formación continuada de todo el personal sanitario y la coordinación con otros servicios proveedores de salud de la red sanitaria se perfilan como los principales puntos a reforzar en el futuro.

Skewed expression and up-regulation of the IL-12 and IL-18 receptors in resting and activated CD4 T cells from HIV-1-infected patients.

IL-12 and IL-18 synergistically induce the production of IFN-gamma by resting and activated T cells. To evaluate whether this induction was affected in HIV-1-infected patients, PBMC or isolated CD4 T cells were cultured with IL-12 plus IL-18, anti-CD3 plus anti-CD28, or PHA for 72 h. Cell samples were labeled daily to assess the levels of IL-12 receptor beta1 (IL-12Rbeta1), IL-12Rbeta2, and IL-18Ralpha. Culture supernatants were analyzed for the presence of Th1- and Th2-related cytokines by ELISA or cytometric bead array and analyzed by flow cytometry. A twofold increase in the percentage of CD4-resting T cells expressing IL-12Rbeta1 and IL-18Ralpha from HIV-1-infected patients was observed when compared with cells from HIV-1-negative donors. Higher IL-12Rbeta1 and IL-18Ralpha expression correlated (r=0.87; P<0.007) to increased production of IFN-gamma by isolated CD4 T cells in the presence of IL-12 and IL-18. Moreover, exogenous IL-12 and IL-18 induced the up-regulation of IL-12Rbeta2 to twice higher in CD4 T cells from HIV-1-positive individuals compared with controls. Conversely, upon activation with anti-CD3 and anti-CD28 antibodies, only 25% of the CD4+ T cells from HIV-1 patients showed an increase in the IL-12beta2 when compared with 50% in healthy controls. Furthermore, the percentage of IL-12Rbeta1-positive cells correlated inversely with the CD4 nadir of patients, suggesting that deregulation of the IL-12 and IL-18 pathways may play a role in the immunopathogenesis of HIV-1 infection.

High prevalence of human papillomavirus infection in the anus, penis and mouth in HIV-positive men.

Human papillomavirus (HPV) types are associated with squamous cell cancers. HIV infection is linked with a higher prevalence of anal HPV infection. It is important to assess whether HPV is present in other body parts involved in sexual practices to establish a cancer prevention program. A high prevalence of high-risk HPV types was present in the anus, penis and mouth (78, 36 and 30%, respectively) in a cohort of HIV-infected males (men who have sex with men and heterosexual), without evidence of pathology in these areas.

Incidence of tuberculosis infection among healthcare workers: risk factors and 20-year evolution.

OBJECTIVE: To determine the incidence of latent tuberculosis infection (LTBI), and risk factors for tuberculosis skin test (TST) conversion among Healthcare workers (HCWs) during a 20-year follow-up period. DESIGN: Prospective cohort analysis. Surveillance was conducted from January 1, 1988, to December 31, 2007. SETTING: 600-bed tertiary referral hospital in Barcelona, Spain. PARTICIPANTS: HCWs in risk for occupational tuberculosis (TB) exposure, with negative baseline TST, direct contact with patients and/or biological samples and at least one follow-up visit with TST. METHODS: TST is performed in HCWs with no previous history of TB or no previous positive TST. When TST is negative this test is performed once a year in high-risk workers, or at least every 2 years according to the hospital's guidelines. In all cases an interview questionnaire to gather information on possible risk factors was performed. RESULTS: The study included 614 HCWs, 27% worked in areas of risk for TB exposure. Annual incidence rate had decreased from 46.8 per 100 person-years in 1990 to 1.08 per 100 person-years in 2007. Cumulative incidence was higher in HCWs who work in high-risk areas (p = 0.004) and in time periods from 1990 to 1995, and from 1996 to 2001 (p < 0.0001). Cox regression model showed a hazard ratio of 1.55 (CI 95%; 1.05-2.27) in high-risk workers, adjusted by gender, age and professional status. CONCLUSIONS: Incidence of LTBI among HCWs is high, although it decreased throughout the follow-up period. It is crucial to maintain surveillance programs in HCWs.

[A study of tuberculosis infection in workers at a university general hospital: associated factors and evolution in 20 years]. / Estudio de la infección tuberculosa en trabajadores de un hospital general universitario. Factores asociados y evolución en 20 años.

OBJECTIVE: To estimate the prevalence of tuberculous infection (TI) in the health-care workers of a hospital over the course of a 20-year period and analyze the associated risk factors. SUBJECTS AND METHODS: A cross-sectional, descriptive study of the workers of a general hospital from 1988 until 2007, using a tuberculin test (TT) and questionnaire. RESULTS: 2,179 workers were studied (mean age 32.4 years (SD 8.4). 24.5% worked in areas at risk for tuberculosis (TB). 8.1% (174) were vaccinated with BCG. The prevalence of positive baseline TT was 25.7% (95% confidence interval: 23.8-27.4%). There was a greater percentage of positive TT in the 1988-1992 period (44.2%) and a smaller percentage (15.8%) in the 2003-2007 period (P<.0001). The prevalence of TI was 1.53 times greater in males and 1.89 in those vaccinated with BCG. When compared with resident physicians, the prevalence of TI was greater in the rest of the professional categories, while increasing 1.03 times per year that age increases and 1.05 times per year of professional activity. CONCLUSIONS: The data provide relevant information about the evolution of TI in hospital professionals over the course of a 20-year period. The prevalence decreased during the study period, probably due to a decrease in the incidence of TB in the reference community and to improved prevention measures and nosocomial control.

El hospital como centro promotor de espacios sin humo: estrategias dirigidas al control del tabaquismo / Hospitals as promoters of smokeless spaces: strategies aimed at smoking control

El objetivo de este trabajo fue describir las medidas llevadas a cabo en el Hospital Germans Trias I Pujol de Barcelona, destinadas a conseguir un entorno libre de humo, así como al desarrollo de actividades de investigación, formación y abordaje clínico en relación al tabaquismo. La experiencia como centro adherido a la Red Catalana de Hospitales Sin Humo desde 2002 nos revela que para la prevención y control del tabaquismo es necesaria una agenda específica desarrollada por un Comité competente, compuesto por trabajadores de diferentes estamentos y servicios del centro. Del mismo modo, consideramos fundamental la coordinación con otros centros de la Red que permita compartir experiencias, así como la implicación de la Dirección del Centro para la implementación efectiva de las estrategias de promoción y protección de la salud, tanto en los trabajadores como en los usuarios. La sensibilización y formación continuada de todo el personal sanitario y la coordinación con otros servicios proveedores de salud de la red sanitaria se perfilan como los principales puntos a reforzar en el futuro

The objective of this study was to describe the measures introduced at the Hospital Germans Trias I Pujol, Barcelona, aimed at achieving a smoke-free environment, and encouraging research, training, and clinical approaches with respect to smoking. The experience gained as a center attached to the Catalan Network of Smokeless Hospitals since 2002 shows that preventing and controlling smoking requires a specific agenda developed by a competent committee comprising workers from all hospital areas. Likewise, coordination with other centers in the network is essential as it permits the sharing of experiences. The involvement of hospital management is critical for the effective introduction of health protection and promotion strategies, both in workers and in users. The raising of awareness and the ongoing training of all health workers and coordination with other health care providers in the health network are the main aspects that require strengthening in the future

Estudio de la infección tuberculosa en trabajadores de un hospital general universitario. Factores asociados y evolución en 20 años / A Study of Tuberculosis Infection in Workers at a University General Hospital. Associated Factors and Evolution in 20 Years

ObjetivoEstimar la prevalencia de infección tuberculosa (IT) en los trabajadores de un hospital a lo largo de un período de 20 años y analizar los factores de riesgo asociados.Sujetos y métodosEstudio descriptivo transversal de los trabajadores de un hospital general desde el año 1988 hasta 2007, mediante prueba de tuberculina (PT) y cuestionario.ResultadosSe han estudiado 2.179 trabajadores (edad media, 32,4 años (DE: 8,4). El 24,5% trabajaban en áreas de riesgo de tuberculosis (TB). El 8,1% (174) estaban vacunados con BCG. La prevalencia de PT positiva basal fue del 25,7% (intervalo de confianza del 95%: 23,8-27,4%). Destaca el mayor porcentaje de PT positivas en el período 1988-1992 (44,2%) y un porcentaje menor (15,8%) en el período 2003-2007 (p<0,0001). La prevalencia de IT fue 1,53 veces superior en varones y 1,89 en vacunados con BCG. En comparación con los MIR, la prevalencia de IT fue superior en el resto de categorías profesionales y se incrementó 1,03 veces por cada año de incremento de edad y 1,05 veces por cada año de actividad profesional.ConclusionesLos datos aportan información relevante sobre la evolución de la IT en los trabajadores del hospital a lo largo de un período de 20 años. La prevalencia disminuyó a lo largo del período estudiado probablemente debido a una disminución de la incidencia de TB en la comunidad de referencia y a una mejora de las medidas de prevención y control nosocomial(AU)

ObjectiveTo estimate the prevalence of tuberculous infection (TI) in the health-care workers of a hospital over the course of a 20-year period and analyze the associated risk factors.Subjects and methodsA cross-sectional, descriptive study of the workers of a general hospital from 1988 until 2007, using a tuberculin test (TT) and questionnaire.Results2,179 workers were studied (mean age 32.4 years (SD 8.4). 24.5% worked in areas at risk for tuberculosis (TB). 8.1% (174) were vaccinated with BCG. The prevalence of positive baseline TT was 25.7% (95% confidence interval: 23.8-27.4%). There was a greater percentage of positive TT in the 1988-1992 period (44.2%) and a smaller percentage (15.8%) in the 2003-2007 period (P<.0001). The prevalence of TI was 1.53 times greater in males and 1.89 in those vaccinated with BCG. When compared with resident physicians, the prevalence of TI was greater in the rest of the professional categories, while increasing 1.03 times per year that age increases and 1.05 times per year of professional activity.ConclusionsThe data provide relevant information about the evolution of TI in hospital professionals over the course of a 20-year period. The prevalence decreased during the study period, probably due to a decrease in the incidence of TB in the reference community and to improved prevention measures and nosocomial control(AU)