Focused testing of people born in high-risk countries could aid prevention, treatment, Kaiser Permanente study suggests
Focused testing for tuberculosis (TB) and chronic hepatitis B infection of patients who were born outside the United States in countries with high TB and hepatitis B burden could identify many patients who may need prevention or treatment, according to new Kaiser Permanente research published in Open Forum Infectious Diseases.
“Both of these infections are prevalent in people born in high-burden countries and can lead to severe disease or even death,” said senior author Jacek Skarbinski, MD, a research scientist with the Kaiser Permanente Division of Research and infectious diseases physician with The Permanente Medical Group. “We have a lot of tools and strategies to prevent and treat both infections to help people lead healthier lives.”
The researchers found 510,361 Kaiser Permanente Northern California (KPNC) members born in countries with a high TB burden, and 322,027 in countries with a high hepatitis B burden. They looked at screening rates and infection prevalence.
Of those born in countries with relatively high rates of both TB and hepatitis B, 30% were screened for TB infection, 65% for chronic hepatitis B, and 23% for both.
Overall, about 10% had a TB infection (detected by skin test or blood test) and 3.1% had chronic hepatitis B (detected by blood test). Other research has found U.S. national averages of 10% and 3% respectively.
The countries with high TB burden among KPNC members are Mexico, Philippines, China, India, Vietnam, El Salvador, and South Korea. The countries with high hepatitis B burden among KPNC members are Philippines, China, Vietnam, and South Korea.
“This is really a key demographic to focus on,” said lead author Jenna Wick, MD, who carried out the work while a medical resident with KPNC. She is now an infectious diseases fellow at Stanford University. “Multiple factors contribute to low screening rates, but there is a great opportunity to use this information to identify patients who could benefit from prevention or treatment.”
Latent or active TB infection can be identified with a skin test or a blood test (latent infection is not transmissible, but can develop into active disease). The authors suggested wider use of the blood test in screening. Treatment of TB infection prevents progression to active TB disease. There is no vaccination to prevent TB.
By contrast, there is a vaccine for hepatitis B. Chronic hepatitis B infection is most commonly transmitted from mother to child through birth or in early childhood; it can be treated with antiviral medication. Untreated hepatitis B can lead to cirrhosis and liver cancer.
“We have treatment for latent TB infection that greatly reduces your risk of ever developing active TB disease,” Skarbinski said. “For hepatitis B, we have screening and prevention strategies, including immunization. There’s huge preventive value to testing for these infections.”
Gaps in testing, treatment
Nationally, there are gaps in identifying people with TB infection, resulting in just 31% of those identified receiving treatment, and 19% completing it. The U.S. Preventive Services Task Force recommends testing and treatment of populations at higher TB infection risk, including non-U.S.-born people.
Half of people in the U.S. with chronic hepatitis B infection have been diagnosed. Updated Centers for Disease Control and Prevention (CDC) guidelines from 2023 recommend one-time universal hepatitis B screening of all adults to find people with chronic infection who could develop more serious disease, and a CDC immunization advisory panel recommends hepatitis B vaccination for all adults aged 19 to 59.
The study authors suggested bundling TB and chronic hepatitis B testing to reduce the number of blood draws and increase screening rates.
The study was funded by the Centers for Disease Control and Prevention.
Additional co-authors were Yuching Ni, MS, and Nicole Halmer, BS, of the Division of Research; Robert J. Wong, MD, MS, of the Stanford University School of Medicine; Amit S. Chitnis, MD, MPH, of the Alameda County Public Health Department; Devan Jaganath, MD, MPH, of the University of California, San Francisco; and Amy L. Krueger, MPH, of the Centers for Disease Control and Prevention.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
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