RT Journal Article
SR Electronic
T1 The global prevalence of latent tuberculosis: a systematic review and meta-analysis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1900655
DO 10.1183/13993003.00655-2019
A1 Adam Cohen
A1 Victor Dahl Mathiasen
A1 Thomas Schön
A1 Christian Wejse
YR 2019
UL http://erj.ersjournals.com/content/early/2019/06/12/13993003.00655-2019.abstract
AB In 1999, the WHO estimated that one-third of the world's 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, p<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 world's 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 as these individuals continuously constitutes an enormous source of potential active TB.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Cohen has nothing to disclose.Conflict of interest: Dr. Mathiasen has nothing to disclose.Conflict of interest: Dr. Schön has nothing to disclose.Conflict of interest: Dr. Wejse has nothing to disclose.