TOPLINE

A meta-analysis of 95 studies including 63,988 healthcare workers (HCWs) and first responders found that latent tuberculosis infection (LTBI) positivity and conversion rates were higher with tuberculin skin tests (TSTs) than with interferon-gamma release assays (IGRAs).

METHODOLOGY

• Researchers conducted a systematic review and meta-analysis to estimate the pooled prevalence and conversion of LTBI among TB-exposed HCWs and first responders and compared estimates derived from TSTs and IGRAs.
• They included 95 studies from 41 countries comprising 63,988 participants, with studies classified according to World Health Organization (WHO) region and national TB incidence category based on 2019 WHO estimates.
• Baseline TB infection prevalence and conversion were analyzed separately, with IGRA and TST conversion rates pooled independently and stratified by follow-up duration.
• Of the studies included, 31 (32.6%) were conducted in high-incidence (TB endemic) regions, 23 (24.2%) in upper-moderate incidence regions, 23 (24.2%) in lower-moderate incidence regions, and 18 (18.9%) in low-incidence regions.

TAKEAWAY

• The pooled IGRA-based LTBI positivity was 22% with substantial heterogeneity, ranging from 6% in low-incidence settings to 38% in high-incidence settings.
• The pooled TST positivity was 38%, with the highest positivity observed in upper-moderate TB incidence regions at 46% and the lowest in low-incidence regions at 13%.
• In 27 studies involving about 10,000 HCWs reporting both tests, the pooled IGRA positivity was 25%, whereas the pooled TST positivity was 46%.
• The pooled conversion rate was 8% with IGRA and 12% with TST; conversion proportions varied by follow-up duration: IGRA conversion was 13% at 1 year, 7% at less than 1 year, and 3% at more than 1 year, whereas TST conversion was 12% at 1 year, 10% at less than 1 year, and 16% at more than 1 year.

IN PRACTICE

“These findings support risk-based TB screening and prevention strategies tailored to local epidemiology and workplace exposure risk, while highlighting the need for further research in ED [emergency department] and first-responder settings,” the authors concluded.

SOURCE

The study was led by Hamoud Alahmari, La Trobe Rural Health School, La Trobe University, Bendigo, Australia. It was published online on July 3, 2026, in the International Journal of Infectious Diseases.

LIMITATIONS

Residual confounding from factors such as the Bacillus Calmette-Guérin vaccination status, foreign-born status, and occupational role could not be ruled out. Evidence for emergency department staff and first responders was limited.

DISCLOSURES

This study received no external funding. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.