Session Type: ePosters
Session Title: ePosters
Authors(s): R. Pop (1), M.B. Kaelin (1), S.P. Kuster (1), H. Sax (2), S. Rampini (3), R. Zbinden (4), C. Relly (2), B. Zacek (5), D. Bassler (6), J. Fontijn (6), C. Berger (2)
Authors Affiliations(s): (1) Department of Infectious Diseases and Hospital Hygiene, University Hospital Zurich, Switzerland, (2) Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland, (3) Department of Internal Medicine, University Hospital Zurich, Switzerland, (4) Institute of Medical Microbiology, University of Zurich, Switzerland, (5) TB Centre of the Lung Association of Canton Zurich (Verein Lunge Zürich), Switzerland, (6) Department of Neonatology, University Hospital Zurich, Switzerland
Background:
Several neonatal intensive care units (NICU) have reported exposure to open tuberculosis (TB) in the past. NICE Guidelines give support regarding the investigation and treatment intervention, but not for close contact definitions. Additionally, data regarding the performance of interferon gamma release assay (IGRA) in neonates and infants is scarce.
We report an investigation management strategy after prolonged exposure to an open miliary TB in a NICU and secondary attack rates in the exposed population. In addition, we evaluated the performance of IGRA in neonates and infants.
Methods:We performed a prospective cohort study of incident tuberculosis infection in NICU patients, their parents and healthcare workers after prolonged exposure to miliary TB of a neonate’s mother. In the absence of established definitions, our team of experts in infection control, neonatology and pediatric infectious diseases defined the following contact definitions and interventions (table 1):
Results:71 of 90 exposed neonates and infants were investigated at baseline, in 51 we conducted a 2nd TST at age of 6 months. No neonate nor infant in our cohort showed a positive TST or IGRA. All responded to Mitogen, being interpreted as a positive control of IGRA and establishing it as a well-functioning test. All IGRA results were concordant to the negative TST results. Therefore, we assume that IGRA could be considered as a reliable investigation tool for excluding latent TB in neonates and infants.
149 of 160 exposed health care works (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection.
5 of 92 exposed primary contacts were tested positive, all coming from countries with high TB burden (figure 1).
Conclusions:
This investigation highlights the low transmission rate of open miliary TB, even in a highly susceptible population such as neonates and infants. Our expert definitions and interventions proved to be useful in terms of feasibility of an thorough outbreak investigation. The repeatedly negative TST results retrospectively support the approach to waive INH-prophylaxis. Furthermore, we demonstrated reliability of IGRA performance compared to TST to rule out latent TB in TB exposed neonates and infants.
Keyword(s): open miliary tuberculosis, neonatal intensive care unit, exposure investigationSession Type: ePosters
Session Title: ePosters
Authors(s): R. Pop (1), M.B. Kaelin (1), S.P. Kuster (1), H. Sax (2), S. Rampini (3), R. Zbinden (4), C. Relly (2), B. Zacek (5), D. Bassler (6), J. Fontijn (6), C. Berger (2)
Authors Affiliations(s): (1) Department of Infectious Diseases and Hospital Hygiene, University Hospital Zurich, Switzerland, (2) Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland, (3) Department of Internal Medicine, University Hospital Zurich, Switzerland, (4) Institute of Medical Microbiology, University of Zurich, Switzerland, (5) TB Centre of the Lung Association of Canton Zurich (Verein Lunge Zürich), Switzerland, (6) Department of Neonatology, University Hospital Zurich, Switzerland
Background:
Several neonatal intensive care units (NICU) have reported exposure to open tuberculosis (TB) in the past. NICE Guidelines give support regarding the investigation and treatment intervention, but not for close contact definitions. Additionally, data regarding the performance of interferon gamma release assay (IGRA) in neonates and infants is scarce.
We report an investigation management strategy after prolonged exposure to an open miliary TB in a NICU and secondary attack rates in the exposed population. In addition, we evaluated the performance of IGRA in neonates and infants.
Methods:We performed a prospective cohort study of incident tuberculosis infection in NICU patients, their parents and healthcare workers after prolonged exposure to miliary TB of a neonate’s mother. In the absence of established definitions, our team of experts in infection control, neonatology and pediatric infectious diseases defined the following contact definitions and interventions (table 1):
Results:71 of 90 exposed neonates and infants were investigated at baseline, in 51 we conducted a 2nd TST at age of 6 months. No neonate nor infant in our cohort showed a positive TST or IGRA. All responded to Mitogen, being interpreted as a positive control of IGRA and establishing it as a well-functioning test. All IGRA results were concordant to the negative TST results. Therefore, we assume that IGRA could be considered as a reliable investigation tool for excluding latent TB in neonates and infants.
149 of 160 exposed health care works (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection.
5 of 92 exposed primary contacts were tested positive, all coming from countries with high TB burden (figure 1).
Conclusions:
This investigation highlights the low transmission rate of open miliary TB, even in a highly susceptible population such as neonates and infants. Our expert definitions and interventions proved to be useful in terms of feasibility of an thorough outbreak investigation. The repeatedly negative TST results retrospectively support the approach to waive INH-prophylaxis. Furthermore, we demonstrated reliability of IGRA performance compared to TST to rule out latent TB in TB exposed neonates and infants.
Keyword(s): open miliary tuberculosis, neonatal intensive care unit, exposure investigation
Session Type: ePosters
Session Title: ePosters
Authors(s): R. Pop (1), M.B. Kaelin (1), S.P. Kuster (1), H. Sax (2), S. Rampini (3), R. Zbinden (4), C. Relly (2), B. Zacek (5), D. Bassler (6), J. Fontijn (6), C. Berger (2)
Authors Affiliations(s): (1) Department of Infectious Diseases and Hospital Hygiene, University Hospital Zurich, Switzerland, (2) Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland, (3) Department of Internal Medicine, University Hospital Zurich, Switzerland, (4) Institute of Medical Microbiology, University of Zurich, Switzerland, (5) TB Centre of the Lung Association of Canton Zurich (Verein Lunge Zürich), Switzerland, (6) Department of Neonatology, University Hospital Zurich, Switzerland
Background:
Several neonatal intensive care units (NICU) have reported exposure to open tuberculosis (TB) in the past. NICE Guidelines give support regarding the investigation and treatment intervention, but not for close contact definitions. Additionally, data regarding the performance of interferon gamma release assay (IGRA) in neonates and infants is scarce.
We report an investigation management strategy after prolonged exposure to an open miliary TB in a NICU and secondary attack rates in the exposed population. In addition, we evaluated the performance of IGRA in neonates and infants.
Methods:We performed a prospective cohort study of incident tuberculosis infection in NICU patients, their parents and healthcare workers after prolonged exposure to miliary TB of a neonate’s mother. In the absence of established definitions, our team of experts in infection control, neonatology and pediatric infectious diseases defined the following contact definitions and interventions (table 1):
Results:71 of 90 exposed neonates and infants were investigated at baseline, in 51 we conducted a 2nd TST at age of 6 months. No neonate nor infant in our cohort showed a positive TST or IGRA. All responded to Mitogen, being interpreted as a positive control of IGRA and establishing it as a well-functioning test. All IGRA results were concordant to the negative TST results. Therefore, we assume that IGRA could be considered as a reliable investigation tool for excluding latent TB in neonates and infants.
149 of 160 exposed health care works (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection.
5 of 92 exposed primary contacts were tested positive, all coming from countries with high TB burden (figure 1).
Conclusions:
This investigation highlights the low transmission rate of open miliary TB, even in a highly susceptible population such as neonates and infants. Our expert definitions and interventions proved to be useful in terms of feasibility of an thorough outbreak investigation. The repeatedly negative TST results retrospectively support the approach to waive INH-prophylaxis. Furthermore, we demonstrated reliability of IGRA performance compared to TST to rule out latent TB in TB exposed neonates and infants.
Keyword(s): open miliary tuberculosis, neonatal intensive care unit, exposure investigationSession Type: ePosters
Session Title: ePosters
Authors(s): R. Pop (1), M.B. Kaelin (1), S.P. Kuster (1), H. Sax (2), S. Rampini (3), R. Zbinden (4), C. Relly (2), B. Zacek (5), D. Bassler (6), J. Fontijn (6), C. Berger (2)
Authors Affiliations(s): (1) Department of Infectious Diseases and Hospital Hygiene, University Hospital Zurich, Switzerland, (2) Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Switzerland, (3) Department of Internal Medicine, University Hospital Zurich, Switzerland, (4) Institute of Medical Microbiology, University of Zurich, Switzerland, (5) TB Centre of the Lung Association of Canton Zurich (Verein Lunge Zürich), Switzerland, (6) Department of Neonatology, University Hospital Zurich, Switzerland
Background:
Several neonatal intensive care units (NICU) have reported exposure to open tuberculosis (TB) in the past. NICE Guidelines give support regarding the investigation and treatment intervention, but not for close contact definitions. Additionally, data regarding the performance of interferon gamma release assay (IGRA) in neonates and infants is scarce.
We report an investigation management strategy after prolonged exposure to an open miliary TB in a NICU and secondary attack rates in the exposed population. In addition, we evaluated the performance of IGRA in neonates and infants.
Methods:We performed a prospective cohort study of incident tuberculosis infection in NICU patients, their parents and healthcare workers after prolonged exposure to miliary TB of a neonate’s mother. In the absence of established definitions, our team of experts in infection control, neonatology and pediatric infectious diseases defined the following contact definitions and interventions (table 1):
Results:71 of 90 exposed neonates and infants were investigated at baseline, in 51 we conducted a 2nd TST at age of 6 months. No neonate nor infant in our cohort showed a positive TST or IGRA. All responded to Mitogen, being interpreted as a positive control of IGRA and establishing it as a well-functioning test. All IGRA results were concordant to the negative TST results. Therefore, we assume that IGRA could be considered as a reliable investigation tool for excluding latent TB in neonates and infants.
149 of 160 exposed health care works (HCW) were investigated. 1 HCW was tested positive, having no other reason than this exposure for latent TB infection.
5 of 92 exposed primary contacts were tested positive, all coming from countries with high TB burden (figure 1).
Conclusions:
This investigation highlights the low transmission rate of open miliary TB, even in a highly susceptible population such as neonates and infants. Our expert definitions and interventions proved to be useful in terms of feasibility of an thorough outbreak investigation. The repeatedly negative TST results retrospectively support the approach to waive INH-prophylaxis. Furthermore, we demonstrated reliability of IGRA performance compared to TST to rule out latent TB in TB exposed neonates and infants.
Keyword(s): open miliary tuberculosis, neonatal intensive care unit, exposure investigation