Read about TBoss launch in QFT news

Issue 1, 2011
“Changing the way
the world looks at TB”
Highlights
Introducing... TB Operation Support Solution (page 1)
New UK TB Testing Guidelines (page 6)
3rd Global IGRA Symposium info (page 10)
In Focus.
Cellestis Launches New Contact Investigation Service, TBoss, in U.S.
Cellestis is excited to announce the launch of
TBoss – TB Operation Support Solution for Public
Health organizations in the United States (US).
TBoss is a comprehensive support service for
contact investigations involving QuantiFERON®TB Gold (QFT®). In this issue, we investigated the
need for and the potential benefits of a service
like TBoss by surveying experts in the field.
11 times greater among foreign-born persons than
among US-born persons.2
Based on WHO modelling,3 the best way to reduce TB
rates is to tackle active TB cases and also identify latent
TB infection in those who are exposed. Hence, ongoing
surveillance and improved TB control and prevention
activities, especially among disproportionately affected
populations, are needed if we are to move towards the
elimination of TB. 
Importance of identifying TB infection
In 2010, a total of 11,181 tuberculosis (TB) cases were
reported in the US, at a rate of 3.6 cases per 100,000,
which was a decline of 3.9% from 2009 and the lowest rate
recorded since national reporting began in 1953.1
Despite overall TB case rates at record lows in the US, the
alarming statistic is that the rate of decline is not nearly enough
to meet the World Health Organization (WHO) and Stop TB
Partnership’s goal of halving active TB cases by 2015.
Although TB cases and rates have decreased in the
US, foreign-born persons and racial/ethnic minorities were
affected disproportionately, with the TB rate (in 2010) being
Diagnose/treat
Latent TB only
Incidence of global TB
Trends in tuberculosis contact investigations
Diagnose/treat
Active TB only
Diagnose/treat
Latent and Active TB
Increase focus area over time to 2050
Theoretical graphic of how treating latent and active TB together can overcome global TB burden.
Model supported by data from Dye & Williams (JR Soc Interface 2008).
1. CDC. Reported tuberculosis in the United States, 2009. Atlanta, GA: US Department of Health and Human Services, CDC; 2010.
2. CDC. Trends in Tuberculosis—United States, 2010. MMWR 2010;60 (11): 333-337.
3. Dye & Williams. J R Soc Interface 2008.
4. CDC. Guidelines for the Investigations of Contacts of Persons with Infectious Tuberculosis. MMWR December 16, 2005/vol 54/No RR-15
Improved TB control obviously extends to management of TB outbreak investigations. With eighty-five percent of
TB cases requiring contact investigations and the average number of contacts per case at 10,3 a staggering amount
of work and resources will be needed.
In the US Centers for Disease Control and Prevention’s (CDC) coverage alone, the headlines are clearly spelling out – and
may be indicative of – the growing need for support during contact tracing exercises. The CDC’s TB-Related News and
Journal Items Weekly Update, posts regular reports about TB, many of which describe significant challenges faced by public
health officials in the contact investigation setting. Some of the clippings posted on the website have been re-created here
for illustrative purposes only. 
s
Dallas Morning New
Sherr y Jacobson
January 27, 2011
KENS5.com
(San Antonio)
James Muñoz January 6, 2011
“The San Antonio Independent
School District (SAISD) is
alerting parents of students
at an elementary school of
possible TB exposure at the
northwest area school. A total
of 655 students are enrolled
at the school; Metro Health
identified 25 students and
staff as being possibly exposed
and in need of screening.
SAISD’s automated phone
system contacted parents of
the affected students, and
Metro Health will send them
letters about TB testing. In
addition, the district will host
an informational meeting for
parents, and students will
receive a TB fact sheet and
letter at school.”
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January 12, 2011
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and notifications began immediate
Contact investigations are highly time-sensitive and
can be riddled with logistical challenges. Whatever the
circumstance, the faster and more efficiently the situation
can be addressed means a greater degree of control,
thereby maximizing the identification of those at risk,
and minimizing any potential for hysteria.
Mr Mike Holcombe, Program Director from the Office
of Tuberculosis and Refugee Health, Mississippi State
Department of Health, agrees and adds that ...“any mass
media attention may have the potential to negatively change
the perspective of the population we are trying to reach.”
What’s involved in contact investigations?
Timeliness in addressing any contact investigation calls
for considerable coordination, organization and mobilization
of resources. Tasks for all those involved are manifold
and include:
• Outbreak investigation coordinators and/or physicians
-- Collating all results and information to determine
contacts’ true risk of TB
-- Ensuring the thoroughness and accuracy of information
-- Implementing a dynamic strategy
-- Establishing priorities
-- Manage all top-level communications
• Public Health managers
-- Identifying staff availability for field work
-- Organizing and mobilizing available staff to
conduct required tasks
• Nurses and/or other healthcare professionals
-- Locating and interviewing contacts
-- Educating the contacts, providing information to
them, and addressing any queries
-- Organizing for contacts to be tested
-- Ensuring availability of testing materials and supplies
-- Performing testing procedures e.g.
• collecting blood and/or performing skin tests
• organizing further tests
• analyzing the results/data
-- Completing associated paperwork
• Suppliers
-- Providing supplies to the correct location at the
correct time
• Laboratory professionals
-- Processing and analyzing results/data
-- Assessing quality of test results
-- Providing results to appropriate team members
as soon as possible
With so many factors and people involved, managing
contact investigations is a huge undertaking for any Public
Health unit. As well as considerations like the constraints
of fiscal management, staffing levels, and appropriate/
adequate staff training and skills, the timeliness of TB test
results is key, especially for larger investigations and those
conducted at institutions such as schools.
The most difficult task is determining
the true risk of the contacts and verifying
who is truly an at-risk contact.
Mr Mike Holcombe, Mississippi State Department of Health.
Choice of diagnostics in TB contact investigations
One of the most difficult tasks in any contact investigation
is to determine a contact’s true risk of exposure to and
development of TB disease. Previously, the only tool
available for identifying TB infection was the Tuberculin
Skin Test (TST), or Mantoux. The TST measures immune
responses to tuberculin PPD, which is made up of a
multitude of bacterial proteins, most of which are present in
the TB vaccine, Bacille Calmette-Guérin (BCG), and shared
with many environmental mycobacteria. The TST has several
limitations including subjective results and frequent false
positives often due to cross-reactivity with BCG vaccination
or responses to environmental mycobacteria.
Most patients prefer QFT to the TST.
Dr Tiffany Harris, NYC Dept of Health & Mental Hygiene.
Despite the TST’s limitations, its use is still widespread.
Perceived lower cost and familiarity of use seem to be major
factors in the continued use of TST.
“There is an unavoidable element of comfort in using
something [TST] that has been around for more than a
hundred years,” said Professor Lee Reichman from Global
Tuberculosis Institute in New Jersey.
Dr Douglas Proops, from New York City’s Department of
Health & Mental Hygiene added that “the TST is a relatively
inexpensive test and when you are testing hundreds and in
rare cases, thousands, cost consideration is very important.”
However, the economic benefit of using the TST is not that
clear-cut. “The perceived low cost of the TST is erroneous
because when one takes into consideration the downstream
costs associated with frequent false positives such as chest
X-rays, other additional clinical examinations and unnecessary
latent TB infection treatments, the cost impact can be
substantial. These downstream costs may not necessarily
be recognized due to the infrastructure of the healthcare
system,” countered Mr Phil Griffin, Director of TB Control and
Prevention, Kansas Department of Health & Environment. 
The most widely-used alternative to the skin test is QFT,
a US Food and Drug Administration (FDA)-approved
interferon-gamma release assay (IGRA). In fact, QFT is a
preferred alternative to the TST in many guidelines and
recommendations throughout the world. The reasons for
this are quite clear: QFT is a highly-specific (99.2%) and
highly-controlled blood test for TB infection. Using enzymelinked immunosorbent assay (ELISA) to detect interferongamma responses in a sample of whole blood incubated
with TB-specific test antigens, QFT provides results showing
an individual’s T-cell response to highly specific antigens
from the TB bacterium. The high-level accuracy of QFT
relates to an increased predictive value over the TST
(Diel et al AJRCCM 2011).
In addition to the heightened accuracy over the skin test,
QFT has many other benefits:
• Results can be available within 24 hours
• Unaffected by previous BCG vaccination and
most other environmental mycobacteria.
• Requires only one patient visit
• Does not boost subsequent test results
• Is a controlled laboratory test
• Provides an objective, reproducible result that
is unaffected by subjective interpretation
How does QFT translate practically in
contact investigations?
The team from New York City Department of Health & Mental
Hygiene comprising the previously mentioned Dr Proops, Dr
Tiffany Harris, Dr Shama Ahuja and Ms Lisa Trieu highlighted
in the survey the many practical benefits associated with
using QFT in the contact investigation setting. With its
increased sensitivity and specificity, QFT is significantly more
precise than the TST in identifying those people who will
progress to active TB disease. Fewer false positives result
in a lessening of workload and allow staff to confidently
target the contacts at true risk. Besides, the TST, despite
being a conventional tool, is not a simple test – it is affected
substantially by subjective interpretation and requires rigorous
training for personnel to deliver consistency in interpretation.
Fewer false positives mean a decreased
workload and allow staff to confidently
target the contacts at true risk.
Dr Tiffany Harris, NYC Dept of Health & Mental Hygiene.
Professor Reichman agrees with the New York team,
saying, “QFT is a controlled laboratory test that provides
an objective, reproducible result unaffected by subjective
interpretation. Laboratories that run QFT tests have to
adhere to high and consistent standards of quality control
whereas healthcare workers who administer the TST do not
have any recognized proficiency standards to aspire to.”
Dr Harris and the New York team cited a number of contact
investigations where QFT was invaluable, for example where
contacts are predicted to have poor TST return rate and
in populations where many have received BCG. “This is
because,” she said, “QFT is unaffected by previous BCG
vaccinations and requires only one patient visit. This also
translates into less staff time.”
“This is especially pertinent when conducting investigations
amongst the homeless or other populations that are
transient or difficult to reach, or when transport is an issue,”
Dr Harris added.
In relation to patient compliance and the TST’s need for a
second patient visit, Dr Harris added, “Most patients prefer
QFT to the TST.”
For larger contact investigations QFT offers a quick
turnaround time, hence enabling a seamless yet effective
operation.
Mr Griffin, who served as past president of the US National
TB Controllers Association, described an example of a large
contact investigation where QFT is ideal. He said, “In a large
contact investigation, you need to test a significant number
of contacts within a relatively short period of time. If this
investigation takes place at an institution such as a school,
you also need to deliver the program in a way that minimizes
disruptions to the school’s schedule. In this type of situation,
the overall test accuracy and logistical advantages associated
with QFT go a long way in producing tangible benefits
for both staff and contacts. There was in fact a recent
investigation at a school in Kansas City, seven phlebotomy
stations were set up to run concurrently, and all the required
testing [using QFT] was completed in a few hours.”
“On a more pragmatic front, the fewer false positive results
means that people are not unnecessarily exposed to chest
X-rays and treatments as well,” Mr Griffin continued.
...the overall test accuracy and logistical
advantages associated with QFT go a long
way in producing tangible benefits for both
staff and contacts...
Phil Griffin, Kansas Department of Health and Environment.
The TST may still have a valuable role in some situations,
for example, in rural areas where the nearest QFT-enabled
laboratory may be miles away and incubation equipment
may not be at-hand, or when drawing blood from patients
is impractical (e.g. intravenous drug abusers with collapsed
veins). “Moreover, the TST appears to be preferred in children
younger than five years old,” added Professor Reichman.
The overwhelming fact, however, is that QFT is generally
more advantageous than TST in contact investigations due
to its strong positive predictive value, overall test accuracy
and logistical advantages. Additionally, it appears to be a test
preferred by both staff and patients for practical reasons.
What can Cellestis offer via the TB Operation Support
Solution (TBoss)?
In view of the recognized challenges associated with
expanded contact investigations and management of
outbreaks, Cellestis has launched TBoss.
The CDC and several Public Health Departments around
the US have requested assistance from Cellestis in
numerous contact investigations throughout the last year.
A homeless shelter investigation in Fulton County (Atlanta,
GA; see coverage in QFT News Issue 3, 2010) and an
outbreak in Kane County (Aurora, IL) are the most notable
and widely discussed of these investigations. Cellestis has
recently also been assisting with a contact investigation
occurring in Alameda County, CA. 
By successfully helping to manage these programs, Cellestis
has demonstrated its ability and commitment to being an
effective partner with Public Health Departments. The key
deliverables to Public Health are:
Customer Support
• Dedicated Cellestis TBoss Program Co-ordinator who will
directly work with the Public Health Official to help identify
resources required
In conjunction with the launch of TBoss, Cellestis
has introduced a range of new materials to help
you and your team get the most out of QFT.
• Assistance with the coordination of phlebotomy resources
for blood collection
• Identification of QFT enabled and preferred laboratories
which will collect the samples, carry out testing and
deliver the results directly to the Public Health Department
How does TBoss work?
Through this program, Cellestis aims to assist with
effective planning and management of complex contact
investigation programs.
Once the need for a contact investigation is determined,
Cellestis can be approached to help facilitate support for
the investigation. The dedicated Cellestis TBoss Program
Co-ordinator will work with the Public Health officials to help
determine which resources are required to effectively collect
blood, handle and store the samples prior to dispatch to
a Cellestis-recommended lab for the generation of results.
The resources identified will be arranged to arrive at the
investigation site at the agreed time.
Cellestis TBoss Program Outline
Department of Health
contacts Cellestis.
Cellestis TBoss Program
Coordinator contacts
Department of Health,
and completes Checklist
identifying resources
required.
Cellestis Program
Co-ordinator contacts
preferred lab; assists
with the coordination of
phlebotomy services, if
required; and arranges
order for appropriate
number of QFT kits.
Cellestis TBoss Program
Co-ordinator organizes
resources & ships to
Department of Health.
Cellestis TBoss
Program Coordinator
contacts Cellestis
Sales Representative
to confirm material
arrival, attendance, and
assistance with set-up
(if required).
New QFT customer support tools
• Clinical Guide: TB Contact Investigations –
Current clinical evidence for using QFT in
contact investigations
• TBoss Brochure – details the overall TBoss
program and service options available
• Patient Brochure – a patient-focused leaflet in
patient-friendly language detailing how a TB
blood test may be used in a contact investigation.
• A free copy of the Diel et al. publication on
(AJRCCM 2011) on QFT predicting progression
to active TB in contacts – available through
www.cellestis.com/dielnpvpub.
You can find all these documents and much
more QFT information on our new web page
dedicated to Contact Investigations
www.cellestis.com/tboss.
Many of these documents are available on
Gnowee (see What’s New in Gnowee? section),
so if you don’t yet have a Gnowee USB card,
please email info@gnowee.net or speak with
your local Cellestis representative.
Latest News
Publications & Guidelines Update
UK National Institute for Health
and Clinical Excellence (NICE)
releases updated guidelines.
NICE Clinical Guideline 117.
“Tuberculosis: Clinical
diagnosis and management of
tuberculosis, and measures
for its prevention and control.”
March 2011.
The 2011 update of the UK’s TB testing guidelines was
released by the NHS in conjunction with World TB Day,
March 24. This update sets a clear pathway for the UK to
tackle its resurgent TB problem by recommending IGRAs as
a first-line test for many groups. Previously, IGRA technology
was only recommended as a second-line test following
a TST. In light of the recent resurgence of TB in many UK
communities, particularly Birmingham, perhaps the most
imperative new recommendation is for IGRA use in household
contacts and in those who have been exposed in an outbreak
situation. You can find a review of QFT’s effectiveness in
predicting progression to active TB disease in the contact
investigation setting in the QFT News progression issue.
The NICE recommendations suggest using IGRAs to
diagnose latent TB in:
• Those with TST-positive results
• Hard-to-reach people (i.e. homeless)
• BCG-vaccinated (i.e. those for whom TST may be
less reliable)
• Contacts
-- In an outbreak situation, aged 5 years and up, IGRA
alone may be considered
-- In the household, aged 2-5 years; IGRA six (6) weeks
after initial negative TST result and child is a contact of
person with sputum-smear-positive TB disease.
• Healthcare workers
-- IGRA if TST-positive
-- IGRA if new healthcare worker recently arrived from
high-incidence countries or who has had contact with
patients in settings where TB is highly prevalent.
• Immigrants from high-incidence countries
-- If aged 5-15 years, IGRA following positive
TST result.
-- If aged 16-35 years, either IGRA test alone or dual TSTIGRA strategy.
• Immunocompromised people
-- With HIV and CD4 counts of 200-500 cells/mm3, either
IGRA alone or IGRA with concurrent TST.
-- If not described in other immunocompromised groups,
IGRA alone or IGRA with concurrent TST.
Read more of the NICE TB Testing Guidelines.
New Recommendations for Contact Tracing
in Tuberculosis from the German Central
Committee against Tuberculosis. May 2011.
The German Central Committee against Tuberculosis
(DZK) has published new recommendations for contact
tracing with IGRAs, which highlight the substantial
utility of IGRAs in Germany for TB contacts. As well
as local relevance in German populations, these
recommendations are important globally because they
are the second set of national guidelines to recommend
IGRAs alone for contact tracing. The Japanese guidelines
from 2008 call for not just IGRA, but specifically QFT,
testing in contact populations.
Compared to the previous recommendations from 2007,
the 2011 DZK update is significant because it:
• Recommends IGRAs as the only test for adult contact
populations that are at least partially BCG vaccinated,
and
• Offers a choice of IGRA or TST in contacts aged five
to 15 years
For children younger than 5 years, the TST remains the
method of choice as sufficient data on IGRA use in this
age group is still in progress.
New Guidance for IGRA testing in Portugal.
May 2011. DGS Orientação nº 012/2011 de
06/05/2011
The DGS in Portugal has updated its guidance for
performing IGRAs. Although still advocating the dual-step
TST-then-IGRA strategy, the DGS states that the added
specificity of confirming positive TST with IGRA avoids
unnecessary treatment. The DGS has also mentioned
that the added sensitivity of IGRAs over TST in high-risk
populations can improve the establishment of treatment.
This may signal that IGRAs are emerging as a first-line
defense for latent TB infection in Portugal.
Read more of the guidance in Portuguese.
European Centre for Disease Prevention and
Control (ECDC) releases “Guidance on Use of
interferon-gamma release assays in support of
TB diagnosis.” March 2011.
The ECDC has published a new guidance document
for use of IGRAs in TB diagnosis. Presenting evidencebased expert opinion from an ad hoc scientific panel, this
document recommends that “IGRAs may be used as
part of the overall risk assessment to identify individuals
for preventive treatment,” including: 
• Immunocompromised persons
• Children
• Close contacts
• Recently-exposed individuals
Furthermore, the panel recommends that IGRAs could play
an important role as part of a diagnostic work-up in the
following groups:
• Patients with extrapulmonary TB
• Patients who test negative for acid-fast bacilli in sputum
and/or negative for M.tuberculosis on culture
Bulgarian latent TB infection recommendations,
“Methodological instructions on guidance, diagnosis,
tracing and treatment of individuals
with latent TB infection.” 27 Jan 2011.
In Bulgaria, the standard test for diagnosing latent TB
infection is the TST. However, these new guidelines
introduce IGRAs as the preferred test for certain groups,
including BCG-vaccinated, those who may not return
for a TST reading, those with uncertain TST results, and
immunosuppressed individuals.
• Children
• Potential infection with non-tuberculous mycobacteria
The ECDC also identifies the need to provide further EUadapted guidance on IGRA use for the identification of both
latent infection and active disease. Read the full ECDC
Guidelines at www.ecdc.europa.eu
New Italian guidelines on TNF-alpha blocker therapy
for inflammatory bowel disease. The Italian Society
of Gastroenterology (SIGE) and the Italian Group for
the study of Inflammatory Bowel Disease (IG-IBD)
Clinical Practice Guidelines: The use of tumor necrosis
factor-alpha antagonist therapy in Inflammatory Bowel
Disease. Dig Liver Dis. 43: 1-20, 2011.
Originally released online in 2010 and recently published
in print, these comprehensive therapy guidelines provide
two specific recommendations concerning IGRAs for TB
screening in patients with inflammatory bowel disease.
Statement 10B and 10C state that either an IGRA or TST can
be used in conjunction with medical work-up for mandatory
TB screening prior to commencement of TNF-alpha blocker
therapy, further noting that IGRAs can also be used to
distinguish a true positive TST from a false positive TST
result caused by BCG sensitisation. Patients with a positive
IGRA and who are to receive TNF-alpha blocker therapy
are recommended TB chemoprophylaxis. If IGRA-negative,
patients should also be treated for LTBI if chest X-ray
indicates remote TB disease or if positive history of prior
TB exposure. Read the full abstract at PubMed.
World TB Day review
Lots of great press coverage surrounding World TB Day –
and Cellestis-sponsored events – this year! Here are a few
highlighted articles from the net:
Unilab (Philippines) steps up on anti-TB drive. This
article, published March 26, features some familiar faces
– Unilab’s Dr Leila Florentino and Cellestis’ Dr Christian
Stoeckigt – during a QFT lab training session. Read the
full Daily Tribune article online.
Denver Stop TB Trot. The third annual Stop TB Trot was
run in Denver on March 20. Over 400 participants, including
Cellestis’ own Carol Giunta, ran or walked the 5km course.
Check out Denver Daily News’ coverage.
TB Awareness Walk. Atlanta. March 19. Over 1500
participants gathered in Grant Park, Atlanta, to support the
US National TB Controllers’ Association’s (NTCA) fundraising
efforts. In addition to the 2-mile walk, the park was filled with
clowns, music, animals, face painting, magician, food and
drinks. For more information on next year’s event, visit
www.tbwalk.org.
Bongs linked to TB. New report from Australia on the
“uncommon” denominator in an active TB cluster.
Click for initial release of this story.
What’s new in Gnowee?
Apologies to those of you who have not been able to
register for Gnowee over the past few weeks. Gnowee has
been experiencing technical difficulties with registrations,
but is now up and running again.
For those who are already registered for Gnowee, the
system is working as normal and you can find more
information at your fingertips with version 1.2. This latest
version offers several new features including exporting full
search results to word processing platforms, and the ability
to edit user information. Log on and check it out!!
Khoury, N. Z., M. J. Binnicker, et al. “Preemployment Screening
for Tuberculosis in a Large Health Care Setting: Comparison of the
Tuberculin Skin Test and a Whole-Blood Interferon-gamma Release
Assay.” J Occup Environ Med 53(3): 290-3.
Lange, C. and H. L. Rieder “Intention to test is intention to treat.” Am
J Respir Crit Care Med 183(1): 3-4.
Lee, S. W., D. K. Oh, et al. “Time Interval to Conversion of Interferon{gamma} Release Assay after Exposure to Tuberculosis.” Eur Respir J.
Legesse, M., G. Ameni, et al. “Performance of QuantiFERON-TB Gold
In-Tube (QFTGIT) for the diagnosis of Mycobacterium tuberculosis (Mtb)
infection in Afar Pastoralists, Ethiopia.” BMC Infect Dis 10(1): 354.
Ling, D. I., A. A. Zwerling, et al. “Immune-based diagnostics for TB in
children: what is the evidence?” Paediatr Respir Rev 12(1): 9-15.
Clinical References
Anibarro, L., M. Trigo, et al. “Interferon-gamma release assays in
tuberculosis contacts: is there a window period?” Eur Respir J 37(1):
215-7.
Apers, L., C. Yansouni, et al. “The Use of Interferon-gamma Release
Assays for Tuberculosis Screening in International Travelers.” Curr Infect
Dis Rep.
Baboolal et al. Comparison of the QuantiFERON®-TB Gold assay
and tuberculin skin test to detect latent tuberculosis infection among
target groups in Trinidad & Tobago. Rev Panam Salud Publica. 2010
Jul;28(1):36-42.
Campbell, P. J., G. P. Morlock, et al. “Molecular Detection of Mutations
Associated with First and Second-Line Drug Resistance Compared with
Conventional Drug Susceptibility Testing in M. tuberculosis.” Antimicrob
Agents Chemother.
Cattamanchi, A., R. Smith, et al. “Interferon-Gamma Release Assays
for the Diagnosis of Latent Tuberculosis Infection in HIV-Infected
Individuals: A Systematic Review and Meta-Analysis.” J Acquir Immune
Defic Syndr 56(3): 230-238.
Chen et al. T-SPOT.TB in the Diagnosis of Active Tuberculosis
Among HIV-Infected Patients with Advanced Immunodeficiency. AIDS
RESEARCH AND HUMAN RETROVIRUSES
Volume 26, Number 00, 2010.
Cruz, A. T., A. M. Geltemeyer, et al. “Comparing the tuberculin skin test
and T-SPOT.TB blood test in children.” Pediatrics 127(1): e31-8.
Cuevas, L. E. “The Urgent Need for New Diagnostics for Symptomatic
Tuberculosis in Children.” Indian J Pediatr.
Diel et al. Interferon-γ release assays for the diagnosis of latent M.
tuberculosis infection: A systematic review and meta-analysis. Eur Respir
J. 2010 Oct 28. [Epub ahead of print]
Ling DI, Pai M, Davids V, Brunet L, Lenders L, Meldau R, Calligaro G,
Allwood B, van Zyl-Smit R, Peter J, Bateman E, Dawson R, Dheda K.
Eur Respir J. 2011 Feb 24. [Epub ahead of print]
Neilson, A. A. and C. A. Mayer “Tuberculosis--prevention in travellers.”
Aust Fam Physician 39(10): 743-50.
Rekha, R. S., S. M. Kamal, et al. “Validation of the ALS Assay in Adult
Patients with Culture Confirmed Pulmonary Tuberculosis.” PLoS ONE
6(1): e16425.
Rieder, H. L., V. K. Chadha, et al. “Guidelines for conducting tuberculin
skin test surveys in high-prevalence countries.” Int J Tuberc Lung Dis 15
Suppl 1: S1-25.
Samandari, T., D. Bishai, et al. “Costs and Consequences of Additional
Chest X-ray in a Tuberculosis Prevention Program in Botswana.” Am J
Respir Crit Care Med.
Thomas et al. Malnutrition and Helminth Infection Affect Performance
of an Interferon [gamma]–Release Assay. PEDIATRICS Volume 126,
Number 6, December 2010
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release assays is not compromised in tuberculosis patients with
diabetes.” Int J Tuberc Lung Dis 15(2): 179-84, i-iii.
van der Werf, M. J. and F. van Leth “Latent tuberculosis infection and
interferon-gamma release assays: what new knowledge did we gain
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Respirology.
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Eisenberg and Pollock. Radiology: Volume 256: Number 3—
September 2010
Presentations
Gandra, et al. Questionable Effectiveness of the QuantiFERON-TB Gold
Test (Cellestis) as a Screening Tool in Healthcare Workers. infection
control and hospital epidemiology december 2010, vol. 31, no. 12.
Carcelain G. IGRA summary. Paris TB Day 2010. (in French)
Hirama, T., K. Hagiwara, et al. “Tuberculosis screening programme
using the QuantiFERON((R))-TB Gold test and chest computed
tomography for healthcare workers accidentally exposed to patients with
tuberculosis.” J Hosp Infect.
Dobb T. Quantiferon Gold. 14 Apr 2010.
Jonnalagadda et al. Latent Tuberculosis Detection by Interferon g Release
Assay during Pregnancy Predicts Active Tuberculosis and Mortality in
Human Immunodeficiency Virus Type 1–Infected Women and Their
Children. The Journal of Infectious Diseases 2010; 202(12):1826–1835
Nienhaus A. QFT in HCW and contact tracing 2010.
Denis L. Origine des prescriptions Lyon. Paris TB Day 2010.
(in French)
Ferry T. IGRA economic aspects. Paris TB Day 2010. (in French)
Miailhes P. QFT Monitoring traitement. TB Day 2010. (in French)
Nienhaus A. QFT in immunosuppression. Hamburg 2010. (in German)
Event Updates
Product Updates
French TB Day, “Symposium
tuberculose et VIH.” Paris, March 28
Environmentally-friendly QFT
packaging now available in US
The latest in the series of IGRA Symposia was held in Paris
at the Institut Pastuer. The main focus for the day was
diagnosis and treatment of TB in patients living with HIV.
Around 250 physicians, microbiologists, immunologists
and other healthcare professionals attended presentations
by TB experts such as Pr. Elisabeth Bouvet, who discussed
the use of IGRAs in latent TB infection screening. The
recommendations regarding IGRA use are currently being
drafted by the French Ministry of Health, and may be
released later this year.
As mentioned in the December 2010 issue
of QFT News, Cellestis is proud to introduce
new, environmentally-friendly packaging for its
QFT ELISA kits. In addition to using sustainable
FSC-endorsed materials, the new sizing will
easier shipping of multiple kits and save space
in the refrigerator. The new packaging is now
being used in the US and will be launched
internationally very soon.
Japan IGRA symposia.
Sapporo, March 12; Nagoya, March 19
Two QFT symposia were successfully held in major cities,
Sapporo and Nagoya, Japan. Over 120 healthcare workers
and physicians attended these symposia, which were
focused on contact investigations and healthcare worker TB
screening in the local area. Chairmen and guest speakers,
who attended from each locale, led in-depth discussions
on recent clinical data, practical actions to control TB, and
screening for patients undergoing TNF-blockade were
highlights of the symposia.
World TB Day IGRA Symposium.
Chicago, March 24
Held at Malcolm X College, the Chicago meeting attracted
over 200 local health officials, physicians, and students.
The keynote speaker, Dr. David Marder, Medical Director of
Occupational Medicine at University of Illinois Medical Center,
discussed his experiences with QFT in the healthcare staff
and students at the University of Illinois-Chicago. 
QuantiFERON-CMV Package
Insert translations now online
The Package Insert for QuantiFERON-CMV
has now been translated into French, German
and Spanish. To view these new inserts, please
visit the international (non-USA) section of
www.cellestis.com and look for the
QuantiFERON-CMV product page and
select Technical Info.
World TB Day IGRA Symposium.
Miami, March 24
Miami-Dade County’s 8th annual World TB Day conference
was held at Jackson Memorial Hospital. This year’s
event was themed, “I Am About TB.” A host of speakers
presented throughout the day to over 100 local physicians
and healthcare workers. Cellestis sponsored the CME
portion of the event.
World TB Day Symposium. Savannah,
Georgia, March 24
This informative luncheon for the Coastal Health District/
Chatham County Public Health was a perfect venue to
discuss QFT and its use in the Public Health setting. Data
on the effectiveness of QFT in contact investigations was
the major topic discussed by the attendees.
World TB Day Symposium.
Houston, Texas, March 24
Houston Department of Health played host to a Cellestissponsored QFT seminar. Several regional experts presented
their experiences with using QFT in Texas.
“Fighting TB in NYC”
Annual TB Conference.
New York City, March 23
The NYC-NJ Department of Health’s
annual TB conference was, held in the
Big Apple. Several speakers, including
Dr. Lee Reichman of the University of
Medicine and Dentistry, New Jersey,
spoke about IGRA technology as it
relates to the city’s fight against TB.
Upcoming Events
Global Symposium on IGRAs 2012.
Hawaii, January 12-15
The third Global Symposium on IGRAs will be held in the
USA early next year. Differing from the previous IGRA
symposiums in Vancouver and Croatia, the Hawaii meeting
will be run as a CME course through the University of
California San Diego (UCSD) School of Medicine. For more
information on program and speakers, please see the
images, inset. To register for this symposium, please visit
https://cme.ucsd.edu/igras.
Although Cellestis will not be directly involved in organizing
the main CME symposium, we will be hosting an adjacent
one-day meeting focused on QFT. To find out more about
Cellestis-sponsored IGRA meetings, simply visit
www.igrasymposium.com, complete the online form
and click submit.
Hope to see you all there!
QFT is approved by the US FDA
QFT is approved by FDA as an in vitro diagnostic aid for detection of Mycobacterium
tuberculosis infection. It uses a peptide cocktail simulating ESAT-6, CFP-10 and
TB7.7(p4) proteins to stimulate cells in heparinized whole blood. Detection of IFN-γ by
ELISA is used to identify in vitro responses to these peptide antigens that are associated
with M. tuberculosis infection.
FDA approval notes that QFT is an indirect test for M. tuberculosis infection (including
disease) and is intended for use in conjunction with risk assessment, radiography and
other medical and diagnostic evaluations.
QFT Package Inserts, available in up to 25 different languages, can be found at
www.cellestis.com.
For more information on TB-related events in the US, please visit http://tb-usaevents.com
Register for information updates on the 3rd IGRA Symposium, planned for 2012. Simply go to www.igrasymposium.com,
complete the online form and click submit.
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