Changing the way the world looks at TB.

In this study of TB infection in HCWs in Malaysia the diagnostic used was not TST, it was Quantiferon TB Gold In Tube. Importantly, unlike other countries they did not use QFT to confirm a TST

a diagnosis of LTBI was made if the respondent was tested positive by Quantiferon TB Gold in-tube test (Cellestis Limited, Carnegie, Australia).

The study also looked at a subset of 95 HCWs who agreed to undertake both the TST and QFT-GIT simultaneously - the results were similar to those from Nienhaus and Korea which had

poor agreement to BCG vaccination in older children and NTM infection [6]. This was probably also the case for respondents in our study. Malaysia’s national immunization programme prior to 2005, involves giving primary BCG vaccination at birth and secondary vaccination at 12 years old.

The study has some statistical significance as of the 1050 eligible health care workers contacted 954 (90.8%) responded.

Whilst Malaysia is an intermediate TB-burden country the results of true TB infection were comparable to countries like Japan and Germany.

The prevalence of LTBI in this study was relatively low when compared to other low and middle income countries

The study also found agreement with other studies in that risks did not conform as anticipated; admin staff were at greater risk of infection than nursing staff.

Does this finding indicate that there is no increased risk of LTBI among HCWs in direct contact with TB patients in Malaysia? Or are the administrative workers just as exposed to TB patients as they worked in the same facility where patients come to seek treatment? Further studies need to be conducted to ascertain these findings.

These findings could influence the rationale and risk analysis to the screening of HCWs.