Knowledge and acceptability of patient-specific infection control measures for pulmonary tuberculosis.

BACKGROUND: Effective infection control measures are essential to reduce tuberculosis (TB) transmission in domestic, workplace, and health care settings. Acceptability of infection control measures is key to patient adherence. METHODS: We used a prospective questionnaire study to determine knowledge and acceptability of potential patient-specific TB infection control measures in a rural South African community. Fifty adult TB suspects were interviewed at investigation, and 50 newly diagnosed TB patients were interviewed at the start and at the end of TB treatment. RESULTS: TB patients and TB suspects had similar knowledge of infection control measures at baseline. Fifty-seven percent of all participants reported knowing the cause of TB, but only 25% correctly identified microbial etiology. Basic cough hygiene was accepted by 98% of participants. Most participants (89%) accepted wearing of face masks in health facilities, but only 42% of TB suspects and 66% of TB patients (P = .016) would accept wearing face masks at home. Only 68% of participants accepted separate cohorting in health facilities and avoidance of co-sleeping with uninfected household members. At the end of treatment, TB patients demonstrated increased knowledge of TB and increased acceptability of certain household infection control measures. CONCLUSION: Acceptability of patient-specific infection control measures within households increases with acquired knowledge of TB. National control programs should maximize early TB education to improve adherence to infection control measures.

The utility of an interferon gamma release assay for diagnosis of latent tuberculosis infection and disease in children: a systematic review and meta-analysis.

BACKGROUND: The utility of interferon gamma release assays (IGRAs) has been assessed in adults, but remains unclear in children. We reviewed the literature on the use of a commercial IGRA in immunocompetent children for the diagnosis of both latent tuberculosis infection (LTBI) and TB disease. METHODS: We searched PubMed for studies published before January 2010 on the diagnosis of TB in children using an IGRA. We compared the specificity and sensitivity of the tuberculin skin test (TST) and the IGRA for LTBI and conducted a random effects meta-analysis on sensitivity of the IGRA for TB disease. RESULTS: Of 68 studies identified, 20 were included in this review. There was increased specificity of the IGRA for LTBI in children compared with TST, but varying sensitivities. Sensitivity of the IGRA in detecting TB disease in children also varied when compared with TST (mean κ score, 0.57). For all TB cases, the pooled sensitivity was 66% (95% confidence interval [CI], 53%-78%) with heterogeneity (I² = 74.8%). Stratification by background TB incidence highlighted a significantly reduced IGRA sensitivity of 55% (95% CI, 37%-73%) in high incidence settings when compared with low incidence settings, 70% (95% CI, 53%-84%). CONCLUSIONS: There was no clear evidence that IGRAs should replace TST for detecting LTBI in children. Sensitivity of the IGRA for TB disease was no different from TST, and a significantly reduced IGRA sensitivity was found in high-burden TB settings compared with low-burden TB settings. Further studies are needed to determine the value of IGRAs in LTBI and TB disease diagnosis in children.