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Comparison of QuantiFERON-TB Gold In-Tube Test and Tuberculin Skin Test for Identification of Latent Mycobacterium tuberculosis Infection in Healthcare Staff and Association Between Positive Test Results and Known Risk Factors for Infection

  • Paul Vinton (a1), Seema Mihrshahi (a1), Paul Johnson (a2), Grant A. Jenkin (a3), Damien Jolley (a4) and Beverley-Ann Biggs (a1)...

We compared a whole-blood interferon-γ release assay (QuantiFERON-TB Gold In-Tube test, hereafter “QFT-in tube test”) with a tuberculin skin test (TST) to determine which test more accurately identified latent Mycobacterium tuberculosis infection in healthcare staff.


A total of 481 hospital staff members were recruited from 5 hospitals in Melbourne, Australia. They provided information about demographic variables and tuberculosis (TB) risk factors (ie, birth or travel in a country with a high prevalence of TB, working in an occupation likely to involve contact with M. tuberculosis or individuals with TB, or being a household contact of an individual with a proven case of pulmonary TB). The QFT-in tube test and the TST were administered in accordance with standardized protocols. Concordance between the test results and positive risk factors was analyzed using the к statistic, the McNemar test, and logistic regression.


A total of 358 participants had both a TST result and a QFT-in tube test result available for comparison. There were fewer positive QFT-in tube test results than positive TST results (6.7% vs. 33.0%; P < .001). Agreement between the tests was poor (71%; к = 0.16). A positive QFT-in tube test result was associated with birth in a country with a high prevalence of TB, the number of years an individual had lived in a country with a high prevalence of TB (ie, the effect of each additional year, treated as a continuous variable), and high-risk occupational contact. A positive TST result was associated with older age, receipt of bacille Calmette-Guérin (BCG) vaccination, and working in an occupation that involved patient contact. Receipt of BCG vaccination was most strongly associated with discordant results in instances in which the TST result was positive and the QFT-in tube test result was negative.


In a population of healthcare staff with a low prevalence of TB and a significant rate of BCG vaccination, a positive QFT-in tube test result was associated with the presence of known risk factors for TB exposure, whereas a positive TST result was more strongly associated with a prior history of BCG vaccination.

Corresponding author
Department of Medicine (RMH/WH), the University of Melbourne, the Royal Melbourne Hospital, Parkville 3050, Australia(
Department of Medicine (RMH/WH), the University of Melbourne, the Royal Melbourne Hospital, Parkville 3050, Australia(
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1.Jereb JA, Kleyens RM, Privett TD, et al.Tuberculosis in health care workers at a hospital with an outbreak of multidrug-resistant Mycobacterium tuberculosis. Arch Intern Med 1995;155:854859.
2.Menzies D, Joshi R, Pai M. Risk of tuberculosis infection and disease associated with work in health care settings. Int J Tuberc Lung Dis 2007;11:593605.
3.Stuart RL, Bennett NJ, Forbes AB, Grayson ML. Assessing the risk of tuberculosis infection among healthcare workers: the Melbourne Mantoux Study. Melbourne Mantoux Study Group. Med J Aust 2001;174:569573.
4.Stuart RL, Grayson ML. Health care workers and tuberculosis. Aust N Z J Med 2000;30:367372.
5.Gandhi NR, Moll A, Sturm AW, et al.Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet 2006;368:15751580.
6.Graham M, Howley TM, Pierce RJ, Johnson PD. Should medical students be routinely offered BCG vaccination? Med J Aust 2006;185:324326.
7.Moran-Mendoza O, Marion SA, Elwood K, Patrick DM, FitzGerald JM. Tuberculin skin test size and risk of tuberculosis development: a large population-based study in contacts. Int J Tuberc Lung Dis 2007;11:10141020.
8.Tissot F, Zanetti G, Francioli P, Zellweger JP, Zysset F. Influence of bacille Calmette-Guerin vaccination on size of tuberculin skin test reaction: to what size? Clin Infect Dis 2005;40:211217.
9.von Reyn CF, Horsburgh CR, Olivier KN, et al.Skin test reactions to Mycobacterium tuberculosis purified protein derivative and Mycobacterium avium sensitin among health care workers and medical students in the United States. Int J Tuberc Lung Dis 2001;5:11221128.
10.Panlilio AL, Burwen DR, Curtis AB, et al.Tuberculin skin testing surveillance of health care personnel. Clin Infect Dis 2002;35:219227.
11.Marsh BJ, San Vicente J, von Reyn CEUtility of dual skin tests to evaluate tuberculin skin test reactions of 10 to 14 mm in healthcare workers. Infect Control Hosp Epidemiol 2003;24:821824.
12.Johnson PD, Stuart RL, Grayson ML, et al.Tuberculin-purified protein derivative-, MPT-64-, and ESAT-6-stimulated gamma interferon responses in medical students before and after Mycobacterium bovis BCG vaccination and in patients with tuberculosis. Clin Diagn Lab Immunol 1999;6:934937.
13.Mazurek GH, Jereb J, Lobue P, Iademarco MF, Metchock B, Vernon A. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep 2005;54(RR-15):4955.
14.Pai M, Riley LW, Colford JM Jr. Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis 2004;4:761776.
15.Nakaoka H, Lawson L, Squire SB, et al.Risk for tuberculosis among children. Emerg Infect Dis 2006;12:13831388.
16.Villarino ME, Mazurek G. Tuberculosis contacts, concerns, and controls: what matters for healthcare workers? Infect Control Hosp Epidemiol 2006;27:433435.
17.World Health Organization. Global Tuberculosis Database 2006. Available at: Accessed November 12, 2007.
18.Broekmans JF, Migliori GB, Rieder HL, et al.European framework for tuberculosis control and elimination in countries with a low incidence: recommendations of the World Health Organization (WHO), International Union against Tuberculosis and Lung Disease (IUATLD) and Royal Netherlands Tuberculosis Association (KNCV) Working Group. Eur Res-pir J 2002;19:765775.
19.The Australian immunisation handbook. 9th ed. Australia: National Health Medical Research Council; 2008:231234. Available at: http: //—home. Accessed January 14, 2009.
20.Department of Human Services. Management, control and prevention of tuberculosis: guidelines for health care providers (2002-2005). Available at: Accessed January 14, 2009.
21.Farris A, Branda J. QuantiFERON-TB Gold assay for tuberculosis infection. Clin Microbiol Newsl 2007;129136.
22.Cellestis. QuantiFERON-TB Gold IT Method and Technical Instructions. Melbourne, Australia: Cellestis; 2007. Available at: Accessed December 12, 2007.
23.Ewer K, Deeks J, Alvarez L, et al.Comparison of T-cell-based assay with tuberculin skin test for diagnosis of Mycobacterium tuberculosis infection in a school tuberculosis outbreak. Lancet 2003;361:11681173.
24.Kang YA, Lee HW, Yoon HI, et al.Discrepancy between the tuberculin skin test and the whole-blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA 2005;293:27562761.
25.Kobashi Y, Obase Y, Fukuda M, et al.Usefulness of QuantiFERON TB-2G, a diagnostic method for latent tuberculosis infection, in a contact investigation of health care workers. Intern Med (Tokyo, Japan). 2007;46:15431549.
26.Pai M, Gokhale K, Joshi R, et al.Mycobacterium tuberculosis infection in health care workers in rural India: comparison of a whole-blood interferon gamma assay with tuberculin skin testing. JAMA 2005;293:27462755.
27.Mazurek GH, Zajdowicz MJ, Hankinson AL, et al.Detection of Mycobacterium tuberculosis infection in United States Navy recruits using the tuberculin skin test or whole-blood interferon-γ release assays. Clin Infect Dis 2007;45:826836.
28.Diel R, Nienhaus A, Lange C, Schaberg T. Cost-optimisation of screening for latent tuberculosis in close contacts. Eur Respir J 2006;28:3544.
29.Jensen PA, Lambert LA, Iademarco MF, Ridzon R. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR Recomm Rep 2005;54(RR-17):1141.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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