QFT. 457 QuantiFERON -TB 2nd Generation QFT m 2 キーワーズ QFT QFT QFT QFT BCG. Kekkaku Vol. 85, No. 6: 547_552, 2010

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1 Kekkaku Vol. 85, No. 6: , QFT 要旨 QFT QuantiFERON -TB 2nd Generation QFT QFT QFT QFT QFT QFT 8 QFT mm QFT m 2 キーワーズ QFT Ⅰ. 緒言 BCG ) QFT Mori 2) gold standard 89% 98% QFT QFT ke-matsumoto@city.osaka.lg.jp Received 2 Nov. 29/Accepted 8 Jan. 2

2 Table Numbers of cases interpreted as infected/ non-infected according to the criteria Criteria No. (%) Infected (any of the following) Positive QFT* Doubtful QFT* Vesicles in TST & Non-infected (any of the following) Doubtful QFT* Negative QFT* No QFT & erythema<3 mm Ⅱ. 方法 QFT ) 3 mm QFT QFT 3 mm QFT QFT QFT QFT QFT 56 ( 66.7) 7 ( 2.2) ( 3.) 84 () 8 ( 3.5) 323 ( 62.7) 74 ( 33.8) 55 () *QFT : QuantiFERON-Gold. This test is done in those with erythema of 3 mm or greater in tuberculin skin test. A doubtful QFT case is interpreted as either infected or non-infected according to the situation, e.g., as infected when there are many positives in the group. & TST: tuberculin skin test. Vesicle formation is supposed to be a very strong reaction. QFT t χ2 SPSS3.J for Windows 5% Ⅲ. 結果 QFT % 7 2.2% 3.% 84 QFT 8 3.5% QFT % 3 mm QFT % 55 Table 6 QFT 5 2 QFT mm QFT 2 mm 9.% 2 mm 5.3% 3 mm 7.5% 4 mm 2% 5 mm 33.8 % QFT 3 mm 3 mm 4 mm 4 mm QFT Table 2 5 mm QFT % % % 7 8.5% 7.7% 6 6.5% Table 2 Frequency of positive QFT according to the erythema diameter of tuberculin test TST (erythema diameter, mm QFT Result (%) ± + Indeterminate 2 (.) 8 (88.9) 48 (84.2) 2 (84.2) 58 (72.5) 44 (55.) 4 (7.) (8.3) 6 (7.5) 8 (.) (.) 3 (5.3) (7.5) 6 (2.) 27 (33.8) 2 (3.5) (.3) (75.3) 29 (8.) 57 (5.8) 3 (.8) 36 TST : tuberculin skin test

3 Infection Risk/K. Matsumoto et al % 2.% Table 3 4 χ Table 4 5 Table 5 Table m 2 Table 7 Table 3 Incidence of infection according to the place of contact with the index case Cases Known contacts Incidence of infection Workplace Hospital Clinic Nursing home Preparatory school No. (%) No. (%) No. tested Infected (%) ( 7.7) ( 8.5) ( 6.5) ( 2.2) ( 2.2) ( 65.5) ( 7.7) ( 6.6) ( 6.3) ( 3.9) (8.5) 2 ( 2.) 3 ( 7.3) 5 (3.2) ( ) 92 () 62 () (3.9) Table 4 Incidence of infection according to the related factors Factor/Category Sex of index case Male Female Age of index case Chest X-ray Lung area Unilateral Bilateral Cavity Absent Present Extent 2 3 Grade of smear positivity Duration of cough Less than 2 months 2 months or over Incidence of infection No. tested Infected (%) (3.5) 2 (5.9) 45 (3.8) 32 (2.3) 7 ( 6.) 9 ( 9.5) 65 (6.6) 22 ( 9.) 62 (7.7) 2 ( 3.6) 53 (5.6) 29 (4.7) ( 3.3) 28 (.2) 55 (8.7) 29 ( 8.4) 55 (22.4) Test p<.5 p<.5 p<. p<. p< (4.)

4 Table 5 Incidence of infection according to duration of contact Duration of contacts (hours) Incidence of infection No. tested Infected (%) P of test of linear trend of proportions=. Table 6 Incidence of infection according to area of space where contacts occurred Space of contacts (sq. meters) Incidence of infection P of test of linear trend of proportions=. 7 (2.) ( 3.8) (.6) 3 ( 8.8) 2 ( 8.3) 8 (5.4) 5 (23.) (2.7) 2 (9.4) 77 (3.9) No. tested Infected (%) (2.9) 7 (5.5) 32 (25.6) 7 ( 7.9) 5 ( 6.9) 4 ( 4.7) 79 (4.4) Ⅳ. 考察 ) QFT QFT QFT QFT QFT 4) Table 7 Odds ratios of incidence of infection according to various factors (Multiple logistic regression analysis) Factor/Category Odds ratio 95%CI Test Type of group Others Medical facility Age of index case 64 years 65 years Chest X-ray Lung area Bilateral Unilateral Cavity Present Absent Extent 2 or 3 Grade of smear positivity or + Duration of cough 2 months or over Less than 2 months Duration of contact hours 99 hours Space of contact 99 sq.meters sq.meters p<.5 p<.5 p<.

5 Infection Risk/K. Matsumoto et al ) QFT 3) 3 mm QFT 8.% 3 mm 6.% 3 mm QFT QFT 3 mm QFT 3 mm QFT QFT 3 mm QFT 2 mm QFT QFT ) G5 2 6) G % 7) 9 39 Grzybowski 8) Sepkowitz 9) Driver ) ) Grzybowski 8) Driver ) Rogers 2) 3) 4) 5) 6) 5 m 2 Ⅴ. まとめ QFT 文献,,,.. 29 ; 84 : Mori T, Sakatani M, Yamagishi F, et al.: Specific Detection of Tuberculosis Infection with an Interferon-gamma Based Assay Using New Antigens. Am J Respir Crit Care Med. 24 ; 7 : INH. 2 28, 2. 4,,,

6 ; 77 : ; 63 : ; 63 : ; 83 : Grzybowski S, Barnett GD, Styblo K : Contacts of cases of active pulmonary tuberculosis. Bull Int Union Tuberc. 975 ; 5 : Sepkowitz KA: How contagious is tuberculosis? Clin Infect Dis. 996 ; 23 : Driver CR, Balcewicz-Sablinska MK, Kim Z, et al.: Contact investigation in congregate settings, New York City. Int J Tuberc Lung Dis. 23 ; 7 : S ,,,.. 2 ; 75 : Rogers EFH : Epidemiology of an outbreak of tuberculosis among school children. Public Health Report. 962 ; 77 : ,,.. 27 ; 9 : ; 78 : ,,, ; 74 : ,.. 2 ; 76 : Original Article TUBERCULOSIS INFECTION BY TUBERCULIN SKIN TEST OR QuantiFERON AND RELATED FACTORS IN CONTACT INVESTIGATIO Kenji MATSUMOTO, Tomomi TATSUMI, Noriko KAMIYA, Kazuyo ARIMA, Shinichi KODA, and Satoshi HIROTA Abstract [Objective] We investigated the factors related to secondary infections in contact group investigations. [Method] From March, 28 to February, 29, a total of 457 tuberculosis (TB) notifications were reviewed by the Health Examination Committee of the Health Centers of Osaka City over indications of a contact investigation. A contact investigation was considered necessary for 92 cases with 62 contacts. For the contacts of these cases, the tuberculin skin test (TST) or / and QuantiFERON-TB 2nd Generation (QFT) was used. The contacts testing positive for QFT were classified as infected. The contacts with doubtful QFT were classified as either infected or non-infected according to the QFTpositive rate of the group as a whole. Those with blisters in TST were classified as infected. [Results] Among the total of 84 infected cases thus defined, 56 were QFT-positive, 7 were doubtful, and had blisters with TST. On the other hand, among the total of 55 uninfected cases, 8 were doubtful on the QFT test, 323 were QFT-negative and 74 were cases with TST of erythema less than 3 mm without QFT test. The relationship between characteristics of index cases and whether a contact was infected or not was as follows: Severe chest X-ray findings, sputum smear positivity, and a cough persisting for more than two months were significantly associated with infection of the contacts. The closeness of contact was also significantly related with a higher risk of infection, so that contact with an index case for more than hours, and contact in a space less than square meters were more likely to cause transmission of infection. [Conclusion] Severity of chest X-ray findings, degree of smear positivity and period of cough were confirmed to be important in judging whether investigations are necessary. The time and space of contact were also considered to be important factors. We should consider these factors comprehensively in order to decide on indications for a contact investigation. Key words: Contact examination, Infection risk, QFT, TST, Index case, Contact status Osaka City Public Health Office Correspondence to: Kenji Matsumoto, Health and Welfare Center of Nishinari Ward, Osaka City, 5 2, Kishinosato, Nishinari-ku, Osaka-shi, Osaka Japan. ( ke-matsumoto@city.osaka.lg.jp)