Interpretation of the 2023 U.S. Preventive Clinical Services Guidelines Workgroup Statement of Recommendations for Screening Adults for Latent Tuberculosis Infection

doi:10.19983/j.issn.2096-8493.2024105

Abstract

Abstract:

Individuals with latent tuberculosis infection constitute a substantial reservoir of potential tuberculosis cases, contributing to ongoing transmission within populations and posing a significant threat to public health and human life. In 2016, the U.S. Preventive Services Task Force introduced guidelines for the screening and treatment of latent tuberculosis infection. However, these guidelines did not clearly define the specific populations that should be targeted by the recommended treatment protocols. Drawing on the latest research evidence, the 2023 U.S. Preventive Services Task Force revised its recommendations on the screening of latent tuberculosis infection in adults. This update seeks to elucidate the screening pathways for latent tuberculosis infection, identify the specific populations that would benefit from treatment regimens, and establish a clear framework for the clinical management of latent tuberculosis infection in adults. This article aims to interpret these updated recommendations and offer guidance for the screening of latent tuberculosis infection in adults within the context of China.

Key words: Mycobacterium tuberculosis, Adults, Infection, Guidelines

CLC Number:

Wu Xiucen, Chen Guihua. Interpretation of the 2023 U.S. Preventive Clinical Services Guidelines Workgroup Statement of Recommendations for Screening Adults for Latent Tuberculosis Infection[J]. Journal of Tuberculosis and Lung Disease , 2024, 5(5): 398-403. doi: 10.19983/j.issn.2096-8493.2024105

Figures/Tables 4

References 28

[1]	Mack U, Migliori GB, Sester M, et al. LTBI: latent tuberculosis infection or lasting immune responses to M.tuberculosis? A TBNET consensus statement. Eur Respir J, 2009, 33(5):956-973. doi:10.1183/09031936.00120908. pmid: 19407047
[2]	Comstock GW, Livesay VT, Woolpert SF. The prognosis of a positive tuberculin reaction in childhood and adolescence. Am J Epidemiol, 1974, 99(2):131-138. doi:10.1093/oxfordjournals.aje.a121593. pmid: 4810628
[3]	Cohen A, Mathiasen VD, Schön T, et al. The global prevalence of latent tuberculosis: a systematic review and meta-analysis. Eur Respir J, 2019, 54(3):1900655. doi:10.1183/13993003.00655-2019.
[4]	World Health Organization. WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment: Module 1: prevention. Geneva: World Health Organization, 2020.
[5]	Mangione CM, Barry MJ, Nicholson WK, et al. Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement. JAMA, 2023, 329(17):1487-1494. doi:10.1001/jama.2023.4899. pmid: 37129649
[6]	Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Reported Tuberculosis in the United States, 2020. Atlanta: United States Centers for Disease Control and Prevention,2021.
[7]	United States Centers for Disease Control and Prevention.Glossary of Tuberculosis Terms. Atlanta: United States Centers for Disease Control and Prevention, 2024.
[8]	Jonas DE, Riley S, Lee L, et al. Screening for Latent Tuberculosis Infection in Adults: An Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US), 2023.
[9]	Kahwati LC, Feltner C, Halpern M, et al. Screening for Latent Tuberculosis Infection in Adults: An Evidence Review for the U.S. Preventive Services Task Force. Rockville (MD): Agency for Healthcare Research and Quality (US), 2016.
[10]	范明宽, 张慧. 《中国社区肺结核主动筛查循证指南》解读. 结核与肺部疾病杂志, 2023, 4(1):1-4. doi:10.19983/j.issn.2096-8493.20230012.
[11]	Sosa LE, Njie GJ, Lobato MN, et al. Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. MMWR Morb Mortal Wkly Rep, 2019. MMWR Morb Mortal Wkly Rep, 2019, 68(19):439-443. doi:10.15585/mmwr.mm6819a3.
[12]	Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis, 2017, 64(2):e1-e33. doi:10.1093/cid/ciw778.
[13]	姜雯雯, 徐勇胜. 结核分枝杆菌潜伏感染筛查方法研究进展. 中国实用儿科杂志, 2023, 38(12):948-952. doi:10.19538/j.ek2023120615.
[14]	郭同磊, 辛赫男, 高磊. 《世界卫生组织结核病整合指南模块1:结核病预防性治疗》解读. 中国防痨杂志, 2023, 45(8):723-727. doi:10.19982/j.issn.1000-6621.20230199.
[15]	Jonas DE, Riley SR, Lee LC, et al. Screening for Latent Tuberculosis Infection in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA, 2023, 329(17):1495-1509. doi:10.1001/jama.2023.3954. pmid: 37129650
[16]	Borisov AS, Bamrah MS, Njie GJ, et al. Update of Recommendations for Use of Once-Weekly Isoniazid-Rifapentine Regimen to Treat Latent Mycobacterium tuberculosis Infection. MMWR Morb Mortal Wkly Rep, 2018, 67(25):723-726. doi:10.15585/mmwr.mm6725a5.
[17]	Borisov AS, Morris SB, Njie GJ, et al. Update of Recommendations for Use of Once-Weekly Isoniazid-Rifapentine Regimen to Treat Latent Mycobacterium tuberculosis Infection. MMWR, 2018, 67(25):723-726. doi:10.15585/mmwr.mm6725a5.
[18]	杨松, 郭建琼, 王乐乐, 等. 世界卫生组织2022年版《敏感结核病治疗指南》解读. 中华结核和呼吸杂志, 2023, 46(6):634-637. doi:10.19982/j.issn.1000-6621.20220330.
[19]	International Union Against Tuberculosis Committee on Prophylaxis. Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial. International Union Against Tuberculosis Committee on Prophylaxis. Bull World Health Organ, 1982, 60(4):555-564.
[20]	丁丞, 嵇仲康, 郑琳, 等. 人群主动筛查策略助力结核病防控. 浙江大学学报(医学版), 2022, 51(6):669-678. doi:10.3724/zdxbyxb-2022-0426.
[21]	Menzies D, Long R, Trajman A, et al. Adverse events with 4 months of rifampin therapy or 9 months of isoniazid therapy for latent tuberculosis infection: a randomized trial. Ann Intern Med, 2008, 149(10):689-697. doi:10.7326/0003-4819-149-10-200811180-00003. pmid: 19017587
[22]	Menzies D, Adjobimey M, Ruslami R, et al. Four Months of Rifampin or Nine Months of Isoniazid for Latent Tuberculosis in Adults. N Engl J Med, 2018, 379(5):440-453. doi:10.1056/NEJMoa1714283.
[23]	Sterling TR, Villarino ME, Borisov AS, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med, 2011, 365(23):2155-2166. doi:10.1056/NEJMoa1104875.
[24]	Sun HY, Huang YW, Huang WC, et al. Twelve-dose weekly rifapentine plus isoniazid for latent tuberculosis infection: A multicentre randomised controlled trial in Taiwan. Tuberculosis (Edinb), 2018, 111:121-126. doi:10.1016/j.tube.2018.05.013.
[25]	Krebs A. The IUAT trial on isoniazid preventive treatment in persons with fibrotic lung lesions. Bull Int Union Tuberc, 1976, 51(1):193-201. pmid: 801115
[26]	Menzies D, Dion MJ, Rabinovitch B, et al. Treatment completion and costs of a randomized trial of rifampin for 4 months versus isoniazid for 9 months. Am J Respir Crit Care Med, 2004, 170(4):445-449. doi:10.1164/rccm.200404-478OC.
[27]	White MC, Tulsky JP, Lee JR, et al. Isoniazid vs. rifampin for latent tuberculosis infection in jail inmates: toxicity and adherence. J Correct Health Care, 2012, 18(2):131-142. doi:10.1177/1078345811435973.
[28]	Sterling TR, Moro RN, Borisov AS, et al. Flu-like and Other Systemic Drug Reactions Among Persons Receiving Weekly Rifapentine Plus Isoniazid or Daily Isoniazid for Treatment of Latent Tuberculosis Infection in the PREVENT Tuberculosis Study. Clin Infect Dis, 2015, 61(4):527-535. doi:10.1093/cid/civ323. pmid: 25904367

目的	评估信息
早期发现、干预、治疗的益处	结核菌素皮肤试验和γ-干扰素释放试验是检测LTBI的准确筛查工具对于评估筛查LTBI的获益研究尚且不足使用疾病预防控制中心推荐的方案治疗LTBI会减少活动性结核病的发展筛查和治疗LTBI与预防活动性结核病的实质性健康益处有关
早期发现、干预、治疗的危害	对于筛查LTBI的危害研究尚且不足采用疾病预防控制中心推荐的方案治疗LTBI的危害程度很小,主要危害是肝毒性 LTBI的筛查和治疗存在轻微危害(主要是肝毒性) 在预防发展为癌症方面具有中等净效益。通过对肺结核感染风险较高的人群进行长期结核感染筛查,预防活动性肺结核

测试	汇总敏感度(%)	汇总特异度(%)
T-SPOT.TB	90	95~97
QFT-GIT	81	99
QFT-Gold Plus	89	98