Latent Tuberculosis Infection among Health Workers in Germany—A Retrospective Study on Progression Risk and Use of Preventive Therapy

Abstract

Despite the decline in tuberculosis incidence (TB) in Germany, health workers (HW) are at greater risk of becoming infected with Mycobacterium tuberculosis. To date, little is known about the risk of progression of latent tuberculosis infections (LTBI) and the use of Tuberculosis Preventive Therapy (TPT) among HW. Routine data from the German Statutory Institution for Accident Insurance and Prevention for Health and Welfare Services (BGW) were analysed and a retrospective survey was conducted. A self-administered questionnaire was sent to 1711 HW who had received recognition of an LTBI as an occupational disease between the years 2009 and 2018. The response rate was 42.3% after correcting for those with no actual address (20.4%). We included 575 HW in the data analysis of the retrospective survey. The cumulative incidence of progression, the incidence density and the associated 95% confidence interval (95% CI) were calculated. Three progressive cases were identified in the analysis of the routine data. In the survey cohort, three HW developed TB during the observation period of 5.4 years on average (standard deviation: 2.8 years; interquartile range: 5.0 years). The cumulative TB incidence was 0.52% in the survey group (95% CI: 0.14% to 1.65%). The incidence density was 0.97 cases per 1000 person years (95% CI: 0.25 to 3.10). One-third of the respondents underwent TPT. Significant differences were observed between age and activity groups in the use of TPT, but not between the genders, year of diagnosis or the reason for performing the screening. The data indicate that the risk of progression of an LTBI is low for HW. However, one-third of the HW had undergone TPT. Information about the expected progression risk is important so that it can be weighed against the risk of side effects of TPT.

Compliance of Healthcare Worker’s toward Tuberculosis Preventive Measures in Workplace: A Systematic Literature Review

“…This finding corroborates the reports by Joseph (2004) [39], whereas Flick (2017) highlighted the rising concern over the state of routine symptoms screening for tuberculosis, as most HCWs did not agree with the procedure and complying with it [48]. The risk of contracting active tuberculosis disease among HCWs was also being highlighted among those with LTBI in Germany [55].…”

Large gap between attitude and action in tuberculosis preventive treatment among tuberculosis-related healthcare workers in eastern China

“…Our survey represents the status of TPT acceptance of TBrelated HCWs in Zhejiang Province in eastern China. In studies in Germany and Korea (Zielinski et al, 2021;Min et al, 2022), one-third of HCWs with LTBI received and completed a course of TPT. This level of acceptance was much higher than in China, which may be related to the use of a short course of treatment (3 months) in both countries (Min et al, 2022).…”

Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose – Update 2023

“…Bei der Interpretation eines positiven IGRA-Ergebnisses sollte beachtet werden, dass die Prävalenz der LTBI bei Beschäftigten im Gesundheitswesen etwa doppelt so hoch ist wie bei Beschäftigten außerhalb [103]. Dies bedeutet, dass bei einer Umgebungsuntersuchung bei Beschäftigten im Gesundheitswesen ein größerer Anteil von Personen mit einer seit längerem bestehenden LTBI und somit einem geringeren Progressionsrisiko detektiert wird [104]. Da ein IGRA nicht in der Lage ist, zwischen alter und neuer Infektion zu unterscheiden, sollte auch berücksichtigt werden, dass bei bis zu 20 % der Beschäftigten im Gesundheitswesen bereits aus der Vorgeschichte ein positiver IGRA bekannt ist.…”

“…Konsequente ärztliche Untersuchungen, die Durchführung eines IGRA und einer JVA ohne Röntgenanlage sowie der duldungspflichtigen TRU ( § 36 Abs. 4 IfSG) bei der Aufnahme von Häftlingen in die JVA tragen dazu bei, Tuberkulosefälle frühzeitig zu erkennen sowie mögliche Übertragungen von MTB und damit Umgebungsuntersuchungen innerhalb der JVA zu vermeiden [104]. Gerade unter den beengten Verhältnissen einer JVA ist das Angebot zu einer präventiven Therapie bei positivem Test sinnvoll und i. d. R. gut durchführbar.…”