Latent Tuberculosis Infection and Occupational Protection among Health Care Workers in Two Types of Public Hospitals in China

Zhou, Feng; Zhang, Li; Gao, Lei; Hao, Yibin; Zhao, Xia; Liu, Jianmin; Lu, Jie; Li, Xiangwei; Yu, Yang; Jun-guo, Chen; Deng, Ying

doi:10.1371/journal.pone.0104673

Cited by 27 publications

(40 citation statements)

References 13 publications

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“…We expect that the majority of TB patients among HCW will be detected between screening appointments, and that the screening programme has increased awareness of the need to report symptoms early. Other studies have found that HCW are at 2–4 times increased risk of TB than the general population [1–6]. We could not confirm this, possibly due to the above mentioned reasons.…”

Section: Discussioncontrasting

confidence: 62%

Feasibility of district wide screening of health care workers for tuberculosis in Zambia

et al. 2017

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BackgroundMany health care workers (HCWs) are at increased risk for tuberculosis (TB). The World Health Organization (WHO) recommends screening HCWs for TB in high burden settings but this is often not implemented in countries with a high TB incidence. We assessed the feasibility of TB screening among HCWs, including participation rate and yield, as part of a project introducing facility specific TB interventions.MethodsThis study had a cross-sectional design. HCWs (including paid staff and community volunteers) from 13 clinics and two hospitals in the Ndola district of Zambia participated. HCWs were screened by a designated person in their own facility. The agreed screening algorithm for HCWs included annual symptom screening, with sputum smear, culture (or Xpert) and chest x-ray offered to HCWs with at least one TB symptom, i.e. those with presumptive TB.ResultsA total of 1011 out of 1619 (62%) staff and 71 out of 138 (51%) community volunteers were screened within one year, total 1082/1757 (62%). Five percent (52/1082) of those screened were presumptive TB patients. Seventy-three percent (38/52) of presumptive TB patients received all diagnostic tests according to the agreed algorithm. Eighteen out of 1757 staff and volunteers combined were diagnosed with TB within a calendar year, showing a notified TB incidence of 1%. At least five of them were diagnosed during the screening appointment (0.5% of those screened). One of the 18 HCWs died of TB. Seventy-six percent (822/1082) of screened HCWs indicated that they already knew their HIV status. Screening was considered feasible if confidentiality can be guaranteed although challenges such as the time required for screening and sample transport were reported.ConclusionsIt is feasible to conduct and implement screening programs for TB among HCWs in hospitals and clinics, and the notified incidence and yield is high. Advocacy is needed to educate managers and HCWs on the importance of screening and the implementation of locally relevant screening algorithms. It is essential to ensure access to TB infection control, diagnostics, treatment and confidential registration for HCW.

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Section: Discussioncontrasting

confidence: 62%

Feasibility of district wide screening of health care workers for tuberculosis in Zambia

et al. 2017

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“…Our study did not find that HCWs who had worked longer periods in TB facilities were more susceptible to be infected with TB [6, 18, 23]. However, results indicated that HCWs aged 51 years or above were at higher risk of contracting TB, in line with the available literature [24]. This might be due to impaired immunity in older people [25] and higher exposure to TB patients [16].…”

Section: Discussionsupporting

confidence: 71%

Prevalence of and risk factors for tuberculosis among healthcare workers in Chinese tuberculosis facilities

Wang

Geng

et al. 2018

Infect Dis Poverty

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BackgroundChina is one of 22 countries with a high tuberculosis (TB) burden in the world. Healthcare workers (HCWs) have a high risk of contracting Mycobacterium tuberculosis infection due to insufficient infection control practices. We conducted a cross-sectional study to explore the prevalence of TB and its associated risk factors among HCWs in Chinese TB facilities.MethodsTwo hundred and forty-one TB facilities employing a total of 9663 HCWs were selected from 12 provinces in China to represent healthcare settings at the provincial, prefectural, and county levels. Structured questionnaires were used to collect information on TB infection control practices and HCWs in those facilities. Data was double entered into EpiData 3.1; TB prevalence and associated risk factors were analyzed using SPSS 21.0 with bivariate and multivariate regression models.ResultsThe results showed that 71 HCWs had been diagnosed with TB, accounting for a prevalence of 760/100 000. The multivariate analysis showed that associated risk factors included belonging to the age group of 51 years and above (aOR: 6.17, 95% CI: 1.35–28.28), being a nurse (aOR = 3.09, 95% CI: 1.15–8.32), implementation of 0–9 items of management measures (aOR = 2.57, 95% CI: 1.37–4.80), and implementation of 0–1 items of ventilation measures (aOR = 2.42, 95% CI: 1.31–4.47).ConclusionThis was the first national large sampling survey on TB prevalence among HCWs in China. It was found that the implementation of TB infection control practices in some facilities was poor. The TB prevalence in HCWs was higher than that in the general population. Therefore, TB infection control practices in Chinese medical facilities should be strengthened.Electronic supplementary materialThe online version of this article (10.1186/s40249-018-0407-6) contains supplementary material, which is available to authorized users.

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“…We hypothesized that this population may be enriched with individuals who made protective humoral responses against Mtb. Healthcare workers (HCWs) in developing world settings have an extremely high exposure to tubercule bacilli because of the lack of appropriate barrier protection and a subsequent raised risk of infection (16,17). We specifically chose to investigate individual responses as opposed to cohort effects because of the experience in the HIV field that showed that protective antibodies were made by only a subset of infected individuals (18).…”

mentioning

confidence: 99%

Latently and uninfected healthcare workers exposed to TB make protective antibodies against Mycobacterium tuberculosis

Wang

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

134

158

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The role of Igs in natural protection against infection by Mycobacterium tuberculosis (Mtb), the causative agent of TB, is controversial. Although passive immunization with mAbs generated against mycobacterial antigens has shown protective efficacy in murine models of infection, studies in B cell-depleted animals only showed modest phenotypes. We do not know if humans make protective antibody responses. Here, we investigated whether healthcare workers in a Beijing TB hospital-who, although exposed to suprainfectious doses of pathogenic Mtb, remain healthy-make antibody responses that are effective in protecting against infection by Mtb. We tested antibodies isolated from 48 healthcare workers and compared these with 12 patients with active TB. We found that antibodies from 7 of 48 healthcare workers but none from active TB patients showed moderate protection against Mtb in an aerosol mouse challenge model. Intriguingly, three of seven healthcare workers who made protective antibody responses had no evidence of prior TB infection by IFN-γ release assay. There was also good correlation between protection observed in vivo and neutralization of Mtb in an in vitro human whole-blood assay. Antibodies mediating protection were directed against the surface of Mtb and depended on both immune complexes and CD4+ T cells for efficacy. Our results indicate that certain individuals make protective antibodies against Mtb and challenge paradigms about the nature of an effective immune response to TB.TB | antibodies | immune complex | humoral immunity | TB restrictors

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Latent Tuberculosis Infection and Occupational Protection among Health Care Workers in Two Types of Public Hospitals in China

Cited by 27 publications

References 13 publications

Feasibility of district wide screening of health care workers for tuberculosis in Zambia

Feasibility of district wide screening of health care workers for tuberculosis in Zambia

Prevalence of and risk factors for tuberculosis among healthcare workers in Chinese tuberculosis facilities

Latently and uninfected healthcare workers exposed to TB make protective antibodies against Mycobacterium tuberculosis

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