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Panel PhysicianPanel PhysicianJuarez, MexicoJuarez, Mexico

What is a Panel Physician?What is a Panel Physician?A local Medical Doctor Selected by the US A local Medical Doctor Selected by the US

Department of State Department of State for the Medical Examination for the Medical Examination of Visa Immigrant Applicantsof Visa Immigrant Applicants

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50,000 Applicants a year50,000 Applicants a yearMexican Citizens applying for a US VisaMexican Citizens applying for a US Visa

All ages All ages From From aall over Mexicoll over Mexico

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Tuberculosis (TB)Tuberculosis (TB)

Mycobacterium Mycobacterium TuberculosisTuberculosis

Tuberculosis (TB)Tuberculosis (TB)

Affects the Affects the lungslungs

AirborneAirborne

HHighly ighly contagiouscontagious

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TB in the WorldTB in the World

Asia · Africa · Eastern EuropeSource: Tuberculosis deaths in 2002. Source: Tuberculosis deaths in 2002. Worldmapper.comWorldmapper.com. 2002. 2002

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TB in MexicoTB in Mexico

Public Health ProblemPublic Health Problem

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66

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77

20072007

CDC Guidelines requires CDC Guidelines requires to screen Visa Applicants to screen Visa Applicants for LTBIfor LTBIand Active TBand Active TB

Offer Treatment toOffer Treatment toActive TB PatientsActive TB Patients

TBTB

How do we Screen How do we Screen

Source: Targeted Tuberculin Testing and Treatment Source: Targeted Tuberculin Testing and Treatment fofo Latent Tuberculosis Infection. MMWR 2000Latent Tuberculosis Infection. MMWR 2000

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ScreeningScreening

Depending of ageDepending of age

Based on clinical and Based on clinical and radiological examinationradiological examination

Smear and CultureSmear and CultureSmear and Culture Smear and Culture

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TreatmentTreatment

We offer Directly We offer Directly Observed Therapy Observed Therapy to Applicants with to Applicants with A ti TB DiA ti TB DiActive TB DiseaseActive TB Disease

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ObjectiveObjective

Evaluate IGRA's sensitivity and Evaluate IGRA's sensitivity and specificity compared with TST in specificity compared with TST in

Mexican Mexican immigrants with abnormal immigrants with abnormal Chest XChest X--Ray and Ray and Health Care WorkersHealth Care Workers

onon o ro r Panel Ph sician ClinicPanel Ph sician Clinic fromfromon on our our Panel Physician ClinicPanel Physician Clinic, from , from December December 2010 to 2010 to December December 20112011

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SelectionSelection

Applicants with abnormal Applicants with abnormal Chest XChest X--Ray Ray

ANDAND

Health Care Workers from the PanelHealth Care Workers from the PanelHealth Care Workers from the Panel Health Care Workers from the Panel Clinic Clinic

MethodologyMethodology

All participants receivedAll participants received

Tuberculin Tuberculin Skin Test Skin Test (TST(TST))

ff GGInterferon Interferon Gamma Gamma Release Assay (IGRA)Release Assay (IGRA)

IGRA: IGRA: QuantiFERONQuantiFERON®®--TB Gold InTB Gold In--Tube Method • Tube Method • CellestisCellestis Inc.Inc.

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MethodologyMethodology

First group First group included included 46 46 subjects with subjects with abnormal abnormal CXRCXR

20 male20 male

26 female26 female

MethodologyMethodology

Second groupSecond groupincluded 30 HCWincluded 30 HCW

21 men21 men

9 women9 women

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Results HCWResults HCW

Table 1

General Characteristics of HCW Participants

n % Mean (SD) Range

CharacteristicSex Male 21 71

Female 9 29Age (years) 39 (12) 23 - 64Diagnosis of other diseaseDiagnosis of other disease

Yes 2 6.5No 29 93.5

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Results HCWResults HCW

Table 2

Results TST & IGRA tests - HCWTest % Mean (SD) Range

TST Positive 35.5TST Negative 64.5

PPD Indurations measure (mm) 5.9 (8.6) 0 -25IGRA Positive 16.7

IGRA Negative 83.3IGRAs IU/ 0.66 (2.0) -0.28 – 10.0( )

Results HCWResults HCW

Table 3

IGRA

TST Positive Negative Total

Positive 3 7 10

Negative 2 18 20

Total 5 25 30

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Results Results Abnormal CRXAbnormal CRX

Table 4General Characteristics of

Abnormal Chest X-Ray Participants n % Mean

(SD) Range

CharacteristicSex Male 20 42.6

Female 27 57.4Age (years) 40 (22) 2 – 81Di i f th diDiagnosis of other disease

Yes 11 23.4No 36 76.6

Results Abnormal CRXResults Abnormal CRX

Table 5

Results TST & IGRA tests – Abnormal CRXTest % Mean (SD) Range

TST Positive 32.6TST Negative 67.4

IGRA Positive 34.0IGRA Negative 66.0

IGRAs IU/ 3.9 (2.9) 0.58 – 7.9( )

P = < 0.0001P = < 0.0001

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Results Abnormal CRXResults Abnormal CRX

Table 6

IGRA

TST Positive Negative Total

Positive 11 4 15

Negative 5 26 31

Total 16 30 46

ResultsResults

Table 8HCW Abnormal C-XR

Sensitivity 29.2 (95% CI 1.3-57.1) 72.7 (95% CI 50.0-95.4)Specificity 90.3 (95% CI 77.6-100) 84.3 (95% CI 72.7-96.9)

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ConclusionConclusion

In our Study, IGRA’s showed a higher In our Study, IGRA’s showed a higher sensitivity in subjects with Abnormal sensitivity in subjects with Abnormal

Chest XChest X--RayRay

Thank YouThank You

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Table 1General Characteristics of Health Care Workers

Participants n % Mean (SD) Range

CharacteristicSex Male 22 71

Female 9 29Age (years) 31 100 39 (12) 23 - 64

Age groups (years)

2 – 14 0 015 – 19 0 020 – 29 10 32.330 – 39 7 22.640 – 49 5 16.1

50 – 59 7 22.6≥ 60 2 6.4

BMI (Kg/mt2) 31 27.4 (3.8) 22.0 – 37.0

BMI groups (Kg/mt2)

<18.5 0 018 5 – 24 9 7 22 618.5 – 24.9 7 22.625.0 – 29.9 14 45.2

≥ 30 10 32.2

Diagnosis of other disease

Yes 2 6.5No 29 93.5

Other diseases: Diabetes 2 100

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Table xGeneral Characteristics of

Abnormal Chest X-Ray Participants n % Mean (SD) Range

CharacteristicSex Male 20 42.6

Female 27 57.4Age (years) 47 100 40 (22) 2 – 81

A ( )Age groups (years)

2 – 14 8 17.015 – 19 3 6.420 – 29 4 8.530 – 39 3 6.440 – 49 9 19.250 – 59 12 25.5

≥ 60 8 17.0*BMI (Kg/mt2) 38 27.4 (5.6) 17.8 – 38.5

*BMI groups (Kg/mt2)

< 18.5 1 2.618.5 – 24.9 11 28.225 0 29 9 11 28 225.0 – 29.9 11 28.2

≥ 30 16 41

Diagnosis of other disease

Yes 11 23.4No 36 76.6

Other diseases: Diabetes 4 36.4Hypertension 2 18.2

Diabetes & Hypertension 2 18.2VIH 1 9.1

Other chronic conditions 2 18.2

* Only participants 15 years old of age and older