Hey, Big Spender

QIAGEN is one of the world’s most successful biotech companies and has achieved outstanding growth in its industry. As a worldwide leading provider of innovative DNA, RNA, and protein purification technologies, and molecular testing solutions to the life science market and to diagnostic laboratories, we have consistently delivered impressive year-on-year revenue increases.

Did that grab your attention? Is this an opportunity too good to miss? Did it press all the right buttons? Carpe diem and all that sort of stuff?

Once you read the fine print, study the evidence, it becomes more like much ado about nothing, just a whole heap of self promotion and hot air preceding a job ad for a temporary position paying a miserly £7.50 per hour for only two weeks!

Independent Expert reports!

to the 2011 National TB Conference and coming from Mississippi

QuantiFERON TB Gold In-Tube testing in the Public Health Laboratory.

..QTF is can replace TST in many populations

Riding the Opportunity Pipeline

You sometimes hear chat about a "pipeline" of new tests for QuantiFERON.


Here are a couple of QuantiFERON "maybes," Hepatitis

This novel, inexpensive assay detected significantly lower specific and global immune responses in patients with advanced recurrent HCV post-LT.

and toxoplasmosis.

These preliminary data according with a previous paper by Peyron et al. suggest that also this commercial test could be useful in early diagnosis of congenital toxoplasmosis and in all cases in which serological test cannot solve diagnostic problems.

Qiagen also has an interest in TB, hepatitis and in congenital toxoplasmosis and QuantiFERON could be helpful in the pre molecular phase.

Discontinuous disclosure.

In today's AFR there is a piece on Cellestis which includes

Those in favour of the bid have queried whether the online poll could be manipulated and note that the results are not audited.

As Cellestis has made no attempt to gauge shareholder opinion on the deal and have no evidence of manipulation their opinion is neither independent or expert. However, when it comes to the unpublished Independent Expert Valuation

The talk is that the opinion will show that the $3.55 a share bid is at the upper end - or, as the bulls are suggesting - above the independent expert's valuation range.

Once again shareholders are treated like the proverbial mushrooms.

Getting the yang of it.

Horse trainer Carolyn Resnick has an interesting piece on how gender affects leadership and ultimately horsemanship (or vice versa)

Masculine energy uses directive leadership and feminine energy uses supportive leadership. Women prefer not to get involved with leadership if they can help it, which is too bad because women are very good in the leadership role if they give their self half a chance.

Women understand something that men still need to consider- and that is leading a horse is part of a co creative process. They also believe that this co creative process is capable of producing the best performance. And that for leadership to really work out- you will need to follow your horse more than you will be leading him in the beginning to create a bond and a willing partner. Once you get this done, a horse will do just about anything for you without a lot of manipulation to get him to do it.

You need to talk to your lawyer

..about TB and clinical negligence. Manchester law firm JMW are representing

a child in a clinical negligence compensation claim in relation to a hospitals error in detecting TB. The client was exposed to a patient with suspected TB whilst in hospital. Unfortunately, our client was not offered any tests to detect TB and as a consequence developed TB meningitis and fell gravely ill. Thankfully our client recovered but sadly developed cerebral palsy and was left significantly disabled.

The lawyers know all about IGRA, perhaps more than the medical community?

The study suggests that a simple blood test know as a Interferon-Gamma Release Assays (IGRAs) will assist in detecting the majority of latent cases and assist in reducing the number of cases of TB in the UK. Another study earlier this year has highlighted the fact that TB cases have risen in the UK by 50% since 1999 which is a worrying statistic.

ASIC -vs- Independent Expert Valuations

KEY POINTS:

*  The regulator has concerns over the independence and objectivity of advice.

*  Investors use such reports to make investment decisions.

*  But some valuers say delays in such reports can increase fees or derail takeovers.

A Tale of Two Identities

Our multiskilled board continues to draw attention, this time from Penton Sutcliffe who implies that Cellestis might be suffering from a dissociative identity disorder..."Perhaps there are now two Cellestis.."

Blame it on the subeditor

Sometimes its the picture that tells the story best

Tony Radford and James Rothel from Cellestis ....40 million reasons each to sell.

Illustration: John Shakespeare

.

Try to be rational Tony

Back in 2010 you said that regarding growth rate comparisons expressed in US$

Both Cytyc and Digene are regarded as models of marketing success and growth in Diagnostics, best practice companies. Both had strong patient advocacy available. Cellestis’ market growth is easily comparable.

Easily comparable. Thanks Tony, I like easy.

So what does all this mean ?

''It's very foolish of anyone to make up their mind ... before they've allowed a very rational debate on the future and potential [of Cellestis],''

and this

Cellestis has not been involved in any of the financial analysis, including any assumptions contained within that financial analysis, contained within information disseminated by any shareholder that may be representing the Cellestis Shareholder Action Group.

and this

The Cellestis Board unanimously recommends that the Cellestis Shareholders vote in favour of the Scheme, and intend to vote the shares that they control, in favour of the Scheme..

There is no Scheme Booklet, no Independent Expert report and as far as I can see, no rational debate - just a whole heap of foolish assumptions made by Cellestis regarding shareholders.

More own goals kicked.

Another insensitive remark made by the accident prone executives of Cellestis, this time from CEO Tony Radford,

''It's very foolish of anyone to make up their mind before they've actually have seen the scheme book, independent expert's report and before they've allowed a very rational debate on the future and potential [of Cellestis],

Obviously his remarks are directed at the board of Cellestis who had made up their mind before seeing the scheme book and the independent expert's report - neither of which are in existence, depending on how one interprets last Fridays ASX announcement.

The facts remain that the board had already recommended that shareholders accept the offer by Qiagen without seeing the scheme book and without seeing an independent expert's report - very foolish indeed.

Profitez des bons moments.

It seems like years ago when France showed an interest in IGRAs,

blood assays could replace TST for antibiotherapy

Later on Madhukar Pai reported that for some situations in France

an IGRA test may replace TST

Roll on 2011 and Madhukar Pai is more clear ie for contact investigations, for HIV patients, those on TNF-a inhibitors, the screening of immigrants and for serial testing of HCWs, France recommends IGRA alone.

TB short course therapy, how long before approval?

No time at all if this is correct;

Rifapentine was approved in June 1998 as a treatment for pulmonary tuberculosis. It is the first new drug approved for tuberculosis in 25 years. It will be sold under the name Priftin and will be available in October 1998. The protocol for the trial is described. Rifapentine will be used in combination with existing therapies, and its safety and efficacy are similar to Rifampin. The Food and Drug Administration praised the manufacturer, Hoechst Marion Roussel, for conducting trials overseas and seeking accelerated approval. There is very little data related to the use of the rifapentine in HIV- positive patients.

Thanks for the heads up, Ron!

By way of an announcement to the Australian Stock Exchange the Chairman of Cellestis, Mr Ron Pitcher, made known the following;

• There is a delay to the original timeline for the proposed Scheme of Arrangement
• There is a group called the Cellestis Shareholder Action Group
• The opinions and analysis of the CSAG are independent of Cellestis.

Whilst I have no problem with the points one and two the third gives me some concern, in particular this phrase

Cellestis has not been involved in any of the financial analysis, including any assumptions contained within that financial analysis, contained within information disseminated by any shareholder

When you consider that much of the "assumptions contained within that financial analysis" were extracted from Cellestis ASX announcements (eg the 2010 AGM presentation) then I am left wondering if Cellestis are now repudiating their own "assumptions?"

Short course TB therapy a game changer.

Just ask Dr Hallberg

Crann: Are these findings enough, as far as you're concerned, to change the way latent TB is treated?

Hallberg: It's very clear that the CDC is already reevaluating their guidelines for treatment. It's pretty rare that you see that, but this is a really good study. It was conducted for 10 years, 8,000 people. I think it is going to lead to a policy change.

QuantiFERON used to differentiate TB from pneumonia.

From Hong Kong, where QFT-GIT was used as an aid to eliminate TB from the diagnosis of pneumonia.

More on the short course therapy for latent TB.

From the LA Times

"The 11 million Americans with latent TB represent a ticking time bomb," Dr. Kenneth Castro, director of the Centers for Disease Control and Prevention's division of tuberculosis elimination, said at a news conference Monday. "They're the source of future TB cases."

and

"It's very clear that, in this country, if we are going to get rid of TB, we have to do so by preventing people at risk from going on to develop the disease," said Dr. Richard Chaisson of the Johns Hopkins University School of Medicine, the senior author of the study. That can only be accomplished by curing latent TB, he said.

Scotland the Brave?

Maybe once, but now just plain misguided

The detection of active TB is the key priority for TB services. The detection of latent TB is developing technologically, but remains a lower priority than active TB.

After that it is all downhill.

US study finds easier way to prevent tuberculosis

16 May 2011

Source: Reuters

* 12-dose combination therapy as good as 270-dose 1 drug regimen

* 82% complete combination therapy -vs- 69% standard therapy

"The combination therapy was found to be safe and as effective as the standard regimen in preventing new cases of TB disease, according to researchers who presented the data at the American Thoracic Society International Conference in Denver."

Warren Buffett on values

Berkshire Hathaway's AGM has become an event comparable to a Royal Wedding. Here are a few bits from 2011;

Q: Do you think Berkshire is currently overvalued?
 
Buffett: If Charlie and I had to stick a number in an envelope right now telling us what the intrinsic value of Berkshire was neither one of us would stick a figure in, we’d stick a range.  It would be ridiculous to come up with a single specific number which encompasses not only the value of the businesses we currently own but what we’re going to do with the excess capital.  Even our ranges will differ slightly and my range may differ tomorrow depending on how I feel, but not dramatically.

UC Davis to sponsor IGRA Symposium

It's all here  (UC Davis being one of the USA's top public research universities)

Title: 3rd Symposium on IGRA'S 2012

Description: Students of tuberculosis have been interested in the immune response to M. tuberculosis since the modern understanding of the clinical disease. For decades the skin test response to tuberculin (TST) was the primary tool clinicians have had for study. With the development of Interferon Gamma Release Assays (IGRA) the recurrent question has been which is better, the TST or an IGRA. Hundreds of papers have been written on this matter and numerous guidelines have been issued. This conference will provide a solid framework within which to assess the rapidly moving field as well as provide a basis for making clinical decisions.

Location City: Waikoloa, HI USA
Start Date: 01/12/2012
End Date: 01/15/2012

Qiagen Downgraded by Investment Firm Macquarie

Link

NEW YORK (GenomeWeb News) – Citing increasing competition in the human papillomavirus testing space and possible austerity measures by the US government, investment firm Macquarie downgraded Qiagen's shares and revised revenue and EPS estimates on Wednesday.

Macquarie also lowered the target price on Qiagen's shares.

The chattering classes

Notice how QuantiFERON has become the generic term for "Interferon Gamma Release Assay?" A selection from the last 24 hours;

Fatigue

I need some advice. I recently tested positive to a TB skin test however I also tested negative to a QuantiFERON-TB Gold blood test.

Coughing

My chest x-ray showed some streaky lesion on the top left lung. Doctor said it's look like TB. I have taken the tuberculin skin test (Result was negative). I have taken the Quantiferon TB Gold blood test (Result was negative). I have done the phlegm test (several times) for Acid Fast Bacilli (Result was negative).

Pregnancy

Doing the TB skin test by itself is not risky but if it is positive, you would need an x ray which is best avoided in pregnancy. Lots of folks have false positive TB skin tests. To avoid this ask for a Quantiferon gold TB test, it is a blood test and is more accurate. More chances of it being negative therefore avoiding the need for an x-ray. We were in the same situation for my wife and this is what we did.

Korea - QuantiFERON in arthritis patients

Another clear endorsement of the QuantiFERON technology as published in the evidence based peer reviewed journal Best Practice & Research: Clinical Rheumatology;

"IGRA may be used instead of TST for the diagnosis of LTBI in patients before starting TNF antagonists in countries where tuberculosis prevalence is intermediate and the BCG vaccination is mandatory at birth, such as in Korea"

Indeterminate Results of QuantiFERON-TB Gold In-Tube Assay in Children.

A good result from within a contentious group; children between 1 month to 18 years old.

"Study results showed the rate of indeterminate QFT-IT results in nonimmunosuppressed children of all age groups to be very low."

ATS 2011 - cost effectiveness of TST vs IGRA in the US

The Cost Effectiveness Of Tuberculin Skin Test And Interferon Gamma Release Assay Screening For Latent Tuberculosis Infection In The U.S.

Link

There were four patterns of cost-effectiveness, relating to four risk categories (Table): 

1) Individuals at highest risk for TB reactivation (HIV-infected and close contacts): IGRA screening was cost-effective compared to TST (ICER <$100,000/quality-adjusted life-year (QALY) gained). 

2) Foreign-born up to age 65 years (recent immigrants and those in the U.S. >5 years): IGRA screening was cost-effective compared to no screening, and cost-saving compared to TST. 

3) Vulnerable populations (homeless, drug users, and former prisoners): the ICER for TST screening was approximately $100,000/QALY gained, but IGRA screening was not cost-effective, and 

4) Patients with chronic medical conditions (renal disease, diabetes, and others): the ICER for screening with either TST or IGRA was >$100,000/QALY gained.

The cost-effectiveness of IGRA was stable across reasonable assumptions about TST and IGRA test characteristics. For example, in foreign-born age 25-44 years, the ICER for IGRA was <$100,000/QALY gained, unless TST specificity was ≥99%. Failure to return for TST interpretation resulted in IGRA identifying more LTBI and being associated with longer life-expectancy than TST. In the foreign-born, where false positive TST are common, superior IGRA specificity resulted in IGRA being cost-saving compared to TST.

Conclusions: TB screening guidelines in the US would be improved and made more cost-effective by recommending screening for the foreign-born regardless of time living in the U.S., and by recommending IGRA screening for HIV-infected, close contacts, recent immigrants, and foreign-born individuals up to age 65. 

ATS 2011 - QuantiFERON in San Francisco

Effectiveness Of QuantiFERON-TB Tests In Tuberculosis Contact Investigation In San Francisco

The findings in this retrospective pilot study suggest QFT may improve LTBI treatment initiation and completion, and support its use as a superior screening method for recently infected contacts. More studies should be conducted.

Link

ATS 2011 - Role of QuantiFERON amongst immigrants.

Role Of The QFT-IT Assay For The Diagnosis Of Latent Tuberculosis Infection Among Adult Immigrants

These preliminary data suggest that the rate of LTBI among adult immigrants from TB endemic countries, in our stusy most of them also close contacts of active TB cases, is significantly lower when detected by QFT-IT, than by TST. Moreover, our findings suggest that using an IGRA test for LTBI screening in this high risk population might reduce the number of candidates to preventive treatment and can provide potential substantial benefits for TB control.

Link

------------------------------

Incidence Of Active Tuberculosis Among High-Risk Immigrants Screened For Latent Tuberculosis Infection Using Interferon-Gamma Release Assays

Although we identified a small number of TB cases during follow-up, the incidence rates of active TB among patients not treated for LTBI were higher than expected. TB control programs should consider LTBI preventive therapy for all high-risk immigrants with positive IGRA results, regardless of prior treatment history. Additional research is needed to clarify the incidence of and risk factors for active TB among high-risk immigrants with negative IGRA results.

Link

-----------------------------

ATS 2011 - Introducing QuantiFERON into routine clinical practice.

What Happens When Blood TB Interferon Gamma Release Assays (IGRA) Are Available In Routine Clinical Practice

In a hospital setting with many TB-at-risk subjects, blood IGRA offers clinicians a simple means of assessing exposure to mycobacteria. However,

1. despite intensive educational measures, it is often employed inappropriately to diagnose active TB;
2. not all positive test results are referred for latent TB treatment evaluation;
3. direct and indirect TB service workload increases dramatically following IGRA roll-out.

Such data should inform planning of TB models of care that incorporate new screening tests

Link

ATS 2011 - QuantiFERON in HIV patients

Improvement In Latent Tuberculosis Testing Of HIV Patients After Switching From The Tuberculin Skin Test To Quantiferon-TB Gold-In-Tube

Adherence to the recommended LTBI screening practices in HIV patients greatly improved following our change from the TST to IGRA blood test. This improvement in LTBI screening using a blood test should be considered when implementing a LTBI screening strategy in a busy urban HIV clinic.

Link

American Journal of Public Health

News from the July Issue Am Jrl of Public Health

A new study from the American Journal of Public Health finds a significant TB burden in large U.S. cities.

Researchers investigated tuberculosis incidence rates and characteristics of patients with TB in large U.S. cities. They categorized 48 cities annually from 2000 to 2007 as reporting decreasing or non-decreasing rates with the data from the Centers for Disease Control and Prevention’s National Tuberculosis Surveillance System. They compared demographic, clinical and treatment characteristics of patients with TB. They found that 42,448 patients with TB in 48 cities accounted for 36 percent of all U.S. patients with TB, comprising 15 percent of the total U.S. population. Researchers also discovered that 29 of the 48 cities showed no significant change in TB incidence over the course of the study, which raises concerns for the elimination of TB.    

The study’s authors wrote, “Our study illustrates the need to address the continuing challenges of urban TB control and highlights some of the factors contributing to variability of TB trends among cities. It is important to detail how specific characteristics of the urban environment shape health and how observations may extend to different urban contexts.”

[From: “Epidemiology of Urban Tuberculosis in the United States, 2000-2007.” Contact: Eyal Oren, Tuberculosis Control Program, Public Health – Harbor View Medical Center, Seattle, Wash., eyal.oren@kingcounty.gov].

Clinical Controversies in Infectious Diseases

That is the topic of this session and in particular TB

Should We Replace Tuberculin Skin Tests (TSTs) with Interferon Gamma Release Assays (IGRAs)? YES

Given that the date is October should Cellestis shareholders, who are presently being distracted by their own "controversy," care?

YES

QuantiFERON and HCWs

Back in January the academics at McGill advised that

Studies have suggested that the lower prevalence of LTBI using IGRAs will result in fewer numbers of HCWs who require preventive therapy. However, the higher rate of subsequent conversions found by IGRA in these studies suggests that, while fewer individuals may be identified as LTBI at baseline, more individuals could be diagnosed with conversions by IGRA leading to more HCWs requiring preventive therapy upon repeated screening.

Faced with this apparent dilemma they advise

Until further evidence is available, TBIC programmes that include IGRA testing must use caution

This hasn't deterred those in Korea

Our data shows the high prevalence of LTBI in the laboratory personnel, and emphasizes the importance of LTBI screening for the health care workers. QFT-G seems to be superior to TST for the LTBI screening.

or Spain

1.- Agreement between TST and QFT was low in vaccinated and non-vaccinated people.
2.- QFT was better than TST for recent tuberculosis infection diagnosis in health care workers because of its high specificity and no interference of booster
3.- QFT was a better indicator for treatment of tuberculosis infection.

Further studies addressing IFN-y sero-convertion and –reversion in health care workers for the follow-up of health care personnel are needed.

On the last point it appears that the lack of evidence on conversions and reversions was not sufficient to halt the use of QuantiFERON.

Another deadly duo - diabetes & TB

From Texas

Findings
The prevalence of diabetes among TB patients was 39% in Texas and 36% in Mexico. Diabetes contributed 25% of the TB cases studied, whereas human immunodeficiency virus (HIV) infection contributed 5% or fewer. Among TB patients, fewer Mexicans than Texans were aware that they had diabetes before this study (4% and 19%, respectively). Men were also less frequently aware than women that they had diabetes (P=0.03). Patients who knew that they had diabetes before the study had an 8-year history of the disease, on average, before being diagnosed with TB.

Conclusion
Patients with diabetes are at higher risk of contracting TB than non-diabetic patients. Integrating TB and diabetes control programmes worldwide would facilitate TB prevention among diabetes patients and increase the number of diabetics who learn of their condition, particularly among males. Such a strategy would lead to earlier case detection and improve the management of both TB and diabetes.

GeorgiaTech give clear and precise instruction.

The Language Institute make sure you get the message

Effective May 16, 2011, students that present to Stamps Health Services for TB testing will receive Quantiferon testing. This is a blood test and is the only TB test now offered. There is a charge of $55.00 for this test.

And that's it.

More good news - QFT and kids

Interferon γ release assay for the diagnosis of latent tuberculosis infection and tuberculosis disease in children

When the flag drops the BS stops

Redflex shareholders give the Scheme of Arrangement the red light

Investment giants Macquarie and Carlyle suffered an embarrassing public defeat this morning when their $300 million takeover of traffic camera group Redflex died in a collision with legal requirements that 75 per cent of voting shareholders support it..

..Shell-shocked investment bankers, along with Redflex executives and directors, milled around at the end of the meeting in central Melbourne which, in spite of its outcome, had almost no debate on the floor.

QuantiFERON useful in non pulmonary TB

Two immigrants with tuberculosis of the ear, nose, and throat region with skull base and cranial nerve involvement.

Richardus RA, Jansen JC, Steens SC, Arend SM.

Source

Department of Infectious Diseases, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

Abstract
We report two immigrants with tuberculosis of the skull base and a review of the literature. A Somalian man presented with bilateral otitis media, hearing loss, and facial and abducens palsy. Imaging showed involvement of both mastoid and petrous bones, extending via the skull base to the nasopharynx, suggesting tuberculosis which was confirmed by characteristic histology and positive auramine staining, while Ziehl-Neelsen staining and PCR were negative. A Sudanese man presented with torticollis and deviation of the uvula due to paresis of N. IX and XI. Imaging showed a retropharyngeal abscess and lysis of the clivus. Histology, acid-fast staining, and PCR were negative. Both patients had a positive Quantiferon TB Gold in-tube result and improved rapidly after empiric treatment for tuberculosis. Cultures eventually yielded M. tuberculosis. These unusual cases exemplify the many faces of tuberculosis and the importance to include tuberculosis in the differential diagnosis of unexplained problems.

Situations Vacant: Cellestis.

Link here

Just Google QuantiFERON

One poster asks

TB Skin Test while pregnant?

I've heard mixed reviews on whether or not you can have a TB skin test while pregnant.  Its required yearly where I work, and I'm due.  Anybody have experience with this?

The response was

My ob didn't recommend it. However, where I work and at my ob there is now a blood draw that can be done instead of the skin test (shot). Could be worth asking about.

ETA: A "little" reading material if you'd like. http://en.wikipedia.org/wiki/QuantiFERON

Counting the Costs of TB Control in Santa Clara County

This article (below the snip) indicates that;

• at $200/$300 per patient treating latent TB is much cheaper than active TB ($10,000/$30,000 per patient)
• budget cuts have reduced TB staff
• new diagnostics, like QuantiFERON, have helped to reduce TB rates in San Francisco
• TB remains a "time-bomb"
  

QuantiFERON in California

Uncertainty about adopting IGRA, or more specifically QuantiFERON, exists amongst health care administrators. For some time California, and in particular San Francisco, has been pioneering the use of QuantiFERON and has been able to build up a store of knowledge. This store is now being put to good use in the seminar 2011: What Do We Know About LTBI? which was recently held at the Curry International Tuberculosis Center.

For instance;

LTBI Diagnosis (in a time of transition)

Clinic staff need to decide which test to take to the field. Which of the following would most strongly influence your choice?
1. Too hard to do blood draw, choose PPD <-- True in some situations
2 Avoid QFT because of logistics of getting blood to lab within 12 hours <-- No more 12 hour limit with QFT-IT
3. Use QFT because only one visit to get results <-- Yes, wasted effort if no show for PPD read
4. QFT because better correlation with exposure risks in contacts to TB <-- Early data suggests QFT may correlate better with exposure and progression

is using IGRAs a cost effective strategy?

Bottom line
• IGRAS are costly up front
• CE studies always show that TST more costly than QFT
• Savings are born from its higher specificity and elimination of waste
• QFT-GIT is affordable and will be cheaper with adequate reimbursement
• T-spot is not competitive at current prices
• Public health programs must be able to bill in order to sustain program

 They even looked at doctor attitudes to managing LTBI

Conclusions

• There are many features of primary care that impact screening and management of LTBI beyond the knowledge of guidelines

• Practice size, type, and the consequent resources contribute to a physicians capacity to track and manage LTBI in a busy primary care practice

• Private practice physicians are less familiar with current guidelines for treatment, and more concerned about insurance, and reimbursement for the care they provide than salaried public sector clinicians

• Educational interventions can improve knowledge of guidelines, but may have little impact on attitudes toward their implementation

• Future interventions should consider different approaches to different practice setting and address priority concerns beyond education

QuantiFERON appears to be a valuable public health tool with potential advantages over the PPD and improving resources.

That's what they are saying in Spain when comparing the performance of QuantiFERON with the 100 year old skin test (actually it is 104 years old).

IGRAs are an accurate indicator of LTI, providing a more specific way of diagnostic and reducing the number of subjects to be treated. QF appears to be a valuable public health tool with potential advantages over the PPD and improving resources.

QuantiFERON continues to clean up.

A big Occupational Health Jamboree is on, this one they are calling Preventing and Treating Biological Exposures. The usual gang will be there;

and there will be a presentation on QuantiFERON;

So, is T. Warner Hudson a good guy or a bad guy; is he an early adopter, a fence sitter or a TB taliban? Here is what he had to say earlier in a survey on HCW testing

I have used QFT in Northern California for all the situations described above for over a year prior to UCLA and loved working QFT compared to TST

Well, what more is there to say?

Contra Costa and QuantiFERON

I like how they think over in Contra Costa County, they don't dither about with what ifs and maybes, they just say it as it is;

Who: Screen all patients for risk of contracting TB or progressing to active TB. High Risk patients should be screened with an appropriate test screening test (TST or IGRA).

and then

High risk patients can be tested with:

TST: at any age. More likely to be false positive in a foreign born person with history of BGC vaccine
IGRA (Quantiferon): Preferred Test. Anyone over the age of 5 years old. Does not give BCG false positives
IGRA (T-SPOT): Children <5 or immunocompromised patients. Send out lab (see below for procedure)

That is their bold, not mine. Further on

All IGRAs are considered equivalent to TST testing. A postive IGRA is the same as a positive TST. IGRAs are not an appropriate test to diagnosis active TB. A negative QFT is not useful in ruling out disease in a symptomatic patient. There are two commercially available IGRA tests: Quantiferon-TB and T-SPOT

Quantiferon: This is our preferred test. Routinely use QFT to test for latent TB in high risk patients. Approved for use age 5 years and older. Available through Contra Cost Public Health Lab and can be drawn at any clinic site using standard lab order form.

At some point you get the message, they want you to use QuantiFERON.

Implementing IGRAs in Public Health Settings: A Tale of Two TB Programs

Following on from last years Webinar the Southeastern National Tuberculosis Center (SNTC) is running more programs including this one;

Implementing IGRAs in Public Health Settings: A Tale of Two TB Programs

Location: A.G. Holley State Hospital

Instructor/speaker: Phil Griffin, Kansas TB Control & Prevention and Charles DeGraw, Louisiana Office of Public Health

Date: 5/16/2011 - 5/16/2011

Time: 10:00 AM - 12:00 PM Eastern

Cost: No Charge

Format: On-Location & Webinar

Description: This presentation reviews the implementation process and subsequent benefits of a modern, streamlined TB screening program being used in the states of Kansas and Louisiana. This presentation describes the concerns that led to consideration of an IGRA to replace the traditional TB skin test in certain populations. There have been challenges to face along the way to full implementation as will be described along with the solutions that were used to overcome the challenges. Results of early use of the IGRAs will be discussed along with the impact it has had on the willingness of patients to accept and complete treatment for latent tuberculosis infection. In addition, the costs associated with both the IGRAs and skin testing will be examined.

The presentation from Kansas might be similar to this one