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The global prevalence of latent tuberculosis: a systematic review and meta-analysis
St Olavs Hosp, Norway.
Statens Serum Inst, Denmark; Aarhus Univ Hosp, Denmark.
Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology, Infection and Inflammation. Linköping University, Faculty of Medicine and Health Sciences.
INDEPTH Network, Guinea Bissau; Aarhus Univ GloHAU, Denmark.
2019 (English)In: European Respiratory Journal, ISSN 0903-1936, E-ISSN 1399-3003, Vol. 54, no 3, article id 1900655Article, review/survey (Refereed) Published
Abstract [en]

In 1999, the World Health Organization (WHO) estimated that one-third of the worlds population had latent tuberculosis infection (LTBI), which was recently updated to one-fourth. However, this is still based on controversial assumptions in combination with tuberculin skin test (TST) surveys. Interferon-gamma release assays (IGRAs) with a higher specificity than TST have since been widely implemented, but never used to estimate the global LTBI prevalence. We conducted a systematic review and meta-analysis of LTBI estimates based on both IGRA and TST results published between 2005 and 2018. Regional and global estimates of LTBI prevalence were calculated. Stratification was performed for low, intermediate and high TB incidence countries and a pooled estimate for each area was calculated using a random effects model. Among 3280 studies screened, we included 88 studies from 36 countries with 41 IGRA (n=67 167) and 67 TST estimates (n=284 644). The global prevalence of LTBI was 24.8% (95% CI 19.7-30.0%) and 21.2% (95% CI 17.9-24.4%), based on IGRA and a 10-mm TST cut-off, respectively. The prevalence estimates correlated well to WHO incidence rates (Rs=0.70, pamp;lt;0.001). In the first study of the global prevalence of LTBI derived from both IGRA and TST surveys, we found that one-fourth of the worlds population is infected. This is of relevance, as both tests, although imperfect, are used to identify individuals eligible for preventive therapy. Enhanced efforts are needed targeting the large pool of latently infected individuals, as this constitutes an enormous source of potential active tuberculosis.

Place, publisher, year, edition, pages
EUROPEAN RESPIRATORY SOC JOURNALS LTD , 2019. Vol. 54, no 3, article id 1900655
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-161417DOI: 10.1183/13993003.00655-2019ISI: 000489163100035PubMedID: 31221810OAI: oai:DiVA.org:liu-161417DiVA, id: diva2:1367034
Note

Funding Agencies|NovoNordisk FoundationNovo Nordisk [NNF15OC0018034]; Swedish Research CouncilSwedish Research Council [201602043]; Swedish Heart and Lung FoundationSwedish Heart-Lung Foundation [20150236]

Available from: 2019-10-31 Created: 2019-10-31 Last updated: 2019-10-31

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