Incidence of tuberculosis infection among healthcare workers: Risk factors and 20-year evolution

Casas, Irma; Esteve, María; Guerola, Rosa; García-Olivé, Ignasi; Roldán‐Merino, Juan; Martínez‐Rivera, Carlos; Ruiz-Manzano, Juan

doi:10.1016/j.rmed.2012.12.008

Cited by 31 publications

(19 citation statements)

References 24 publications

(17 reference statements)

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“…Our study demonstrated that, although there is an association between the risks of a positive TST or IGRA with a working exposure, this risk was not associable with working in high-risk areas; as previously described, some authors found an association with working in wards, as emergency department, where undiagnosed patients are seen [24]. …”

Section: Discussionsupporting

confidence: 70%

Screening for Tuberculosis in Health Care Workers: Experience in an Italian Teaching Hospital

Napoli

Ferretti

Ninno

et al. 2017

BioMed Research International

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Health care workers (HCW) are particularly at risk of acquiring tuberculosis (TB), even in countries with low TB incidence. Therefore, TB screening in HCW is a useful prevention strategy in countries with both low and high TB incidence. Tuberculin skin test (TST) is widely used although it suffers of low specificity; on the contrary, the in vitro enzyme immunoassay tests (IGRA) show superior specificity and sensitivity but are more expensive. The present study reports the results of a three-year TB surveillance among HCW in a large teaching hospital in Rome, using TST (by standard Mantoux technique) and IGRA (by QuantiFERON-TB) as first- and second-level screening tests, respectively. Out of 2290 HCW enrolled, 141 (6.1%) had a positive TST; among them, 99 (70.2%) underwent the IGRA and 16 tested positive (16.1%). The frequency of HCW tested positive for TB seems not far from other experiences in low incidence countries. Our results confirm the higher specificity of IGRA, but, due to its higher cost, TST can be considered a good first level screening test, whose positive results should be further confirmed by IGRA before the patients undergo X-ray diagnosis and/or chemotherapy.

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Section: Discussionsupporting

confidence: 70%

Screening for Tuberculosis in Health Care Workers: Experience in an Italian Teaching Hospital

Napoli

Ferretti

Ninno

et al. 2017

BioMed Research International

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“…cough-inducing procedures, myobacteriology or pathology laboratory work [16]. They were assumed to have a 4.4% annual probability of exposure to contagious TB, corresponding to the ‘moderate-risk’ group described by Salpeter et al in 2004 [17], and reflecting more recent incidence data reported by Lambert et al in 2012 [12].…”

Section: Methodsmentioning

confidence: 99%

“…Since our focus was HCWs at risk of developing TB infection, we did not consider the lowest-risk workers, clerical, maintenance and laundry employees [16]. Similarly, we assumed that all HCWs in the cohort worked in hospitals where TB patients were likely to be admitted (i.e.…”

Section: Methodsmentioning

confidence: 99%

Revisiting annual screening for latent tuberculosis infection in healthcare workers: a cost-effectiveness analysis

Mullie

Schwartzman

Zwerling

et al. 2017

BMC Med

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BackgroundIn North America, tuberculosis incidence is now very low and risk to healthcare workers has fallen. Indeed, recent cohort data question routine annual tuberculosis screening in this context. We compared the cost-effectiveness of three potential strategies for ongoing screening of North American healthcare workers at risk of exposure. The analysis did not evaluate the cost-effectiveness of screening at hiring, and considered only workers with negative baseline tests.MethodsA decision analysis model simulated a hypothetical cohort of 1000 workers following negative baseline tests, considering duties, tuberculosis exposure, testing and treatment. Two tests were modelled, the tuberculin skin test (TST) and QuantiFERON®-TB-Gold In-Tube (QFT). Three screening strategies were compared: (1) annual screening, where workers were tested yearly; (2) targeted screening, where workers with high-risk duties (e.g. respiratory therapy) were tested yearly and other workers only after recognised exposure; and (3) post exposure-only screening, where all workers were tested only after recognised exposure. Workers with high-risk duties had 1% annual risk of infection, while workers with standard patient care duties had 0.3%. In an alternate higher-risk scenario, the corresponding annual risks of infection were 3% and 1%, respectively. We projected costs, morbidity, quality-adjusted survival and mortality over 20 years after hiring. The analysis used the healthcare system perspective and a 3% annual discount rate.ResultsOver 20 years, annual screening with TST yielded an expected 2.68 active tuberculosis cases/1000 workers, versus 2.83 for targeted screening and 3.03 for post-exposure screening only. In all cases, annual screening was associated with poorer quality-adjusted survival, i.e. lost quality-adjusted life years, compared to targeted or post-exposure screening only. The annual TST screening strategy yielded an incremental cost estimate of $1,717,539 per additional case prevented versus targeted TST screening, which in turn cost an incremental $426,678 per additional case prevented versus post-exposure TST screening only. With the alternate “higher-risk” scenario, the annual TST strategy cost an estimated $426,678 per additional case prevented versus the targeted TST strategy, which cost an estimated $52,552 per additional case prevented versus post-exposure TST screening only. In all cases, QFT was more expensive than TST, with no or limited added benefit. Sensitivity analysis suggested that, even with limited exposure recognition, annual screening was poorly cost-effective.ConclusionsFor most North American healthcare workers, annual tuberculosis screening appears poorly cost-effective. Reconsideration of screening practices is warranted.

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“…A longer period of employment as health professional, patient's delayed diagnosis of the disease, professional category certain work locations such as inpatient TB facility laboratory, internal medicine, and emergency facilities in addition to the lack of proper respiratory protection (N95 masks), are factors that can contribute to the infection. 25 TB is more prevalent in the young adult working-age population than in the general population. 26 Although most studies do not specify a relation between the development of TB and the mean age in HCW and non-HCW, our findings show that among those occupationally-acquired TB, those who were 43 years or older with greater, were…”

Section: 17mentioning

confidence: 97%

Analysis of Occupational Tuberculosis in the Brazilian National Recording System, 2007–2011

Nunes

Prado

Souza

et al. 2017

Rev Epidemiol Control Infect

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Exceto onde especificado diferentemente, a matéria publicada neste periódico é licenciada sob forma de uma licença Creative Commons -Atribuição 4. Conclusões: Evidenciou-se a necessidade de atenção para a TB como uma doença ocupacional, sendo importante o fortalecimento das discussões sobre os direitos dos trabalhadores, especialmente para os N-PS e a implementação de medidas de saúde pública para a prevenção e controle da doença nesses grupos. Descritores: Tuberculose. Saúde do Trabalhador. Sistemas de Informação em saúde.Background and Objectives: Health care workers (HCWs) are among the groups at risk for contracting tuberculosis (TB). However, few studies have analyzed this subject in other professions (non-HCWs). This study aimed to characterize and analyze factors associated with TB according to their occupational status, defined as workplace-acquired TB (HCWs or non-HCWs). Methods: Cross-sectional study that used the Brazilian National Surveillance System (SINAN) database, which includes data related to occupational TB transmission. Results:The proportion of TB cases attributable to occupational TB based on data from 2007 to 2011 in Brazil was 1.6%. We analyzed 3,049 subjects, of which 298 (10%) were TB -HCWs and 2,751 (90%) were TB -non-HCWs. HCWs were less likely to be male (OR = 0.24, 95%CI: RESUMO ABSTRACT ARTIGO ORIGINAL

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Incidence of tuberculosis infection among healthcare workers: Risk factors and 20-year evolution

Abstract: Incidence of LTBI among HCWs is high, although it decreased throughout the follow-up period. It is crucial to maintain surveillance programs in HCWs.

Cited by 31 publications

References 24 publications

Screening for Tuberculosis in Health Care Workers: Experience in an Italian Teaching Hospital

Screening for Tuberculosis in Health Care Workers: Experience in an Italian Teaching Hospital

Revisiting annual screening for latent tuberculosis infection in healthcare workers: a cost-effectiveness analysis

Analysis of Occupational Tuberculosis in the Brazilian National Recording System, 2007–2011

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