Not Tb-proof: latent tuberculosis in Kuala Lumpur Hospital health care workers

Munisamy, Murallitharan; Krishnan, K. S.; Selvaratnam, G.; Panza, Alessio; Pongpanich, Sathirakorn; Jimba, Masamine

doi:10.1093/occmed/kqx015

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…The prevalence of M. tuberculosis infection based on TST positivity in general hospital settings in other LMICs ranged from 15.4% to 71.8% ( Belo and Naidoo, 2017 ; Borroto et al, 2011 ; De Oliveira et al, 2007 ; He et al, 2012 ; Li-fan et al, 2013 ; Munisamy et al, 2017 ; Ozdemir et al, 2006 ; Powell et al, 2011 ; Rutanga et al, 2015 ; Van Rie et al, 2013 ; Zhou et al, 2014 ). These results included all types of HCWs, as well as administrative personnel.…”

Section: Discussionmentioning

confidence: 99%

“…A similar result was reported in previous studies in LMICs ( Belo and Naidoo, 2017 ; Li-fan et al, 2013 ; Mirtskhulava et al, 2008 ; Powell et al, 2011 ; Rutanga et al, 2015 ; Van Rie et al, 2013 ), although some of these studies compared HCWs providing direct patient care to those in management, administration and support. Two studies ( Munisamy et al, 2017 ; Nasehi et al, 2017 ) reported that HCWs providing health services had a higher prevalence of M. tuberculosis infection than management, administration and support workers.…”

Section: Discussionmentioning

confidence: 99%

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Mycobacterium tuberculosisinfection and disease in healthcare workers in a tertiary referral hospital in Bandung, Indonesia

Apriani

McAllister

Sharples

et al. 2022

Journal of Infection Prevention

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Background Healthcare workers (HCWs), especially in high tuberculosis (TB) incidence countries, are at risk of Mycobacterium tuberculosis infection and TB disease, likely due to greater exposure to TB cases and variable implementation of infection control measures. Aim We aimed to estimate the prevalence of tuberculin skin test (TST) positivity, history of TB and to identify associated risk factors in HCWs employed at a tertiary referral hospital in Bandung, Indonesia. Methods A cross-sectional study was conducted from April to August 2018. A stratified sample of the HCWs were recruited, screened by TST, assessed for TB symptoms, history of TB disease and possible risk factors. Prevalence of positive TST included diagnosis with TB after starting work. HCWs with TB disease diagnosed earlier were excluded. Survey weights were used for all analyses. Possible risk factors were examined using logistic regression; adjusted odds ratios and 95% confidence intervals (CI) are presented. Results Of 455 HCWs recruited, 42 reported a history of TB disease (25 after starting work) and 395 had a TST result. The prevalence of positive TST was 76.9% (95% CI 72.6–80.8%). The odds increased by 7% per year at work (95% CI 3–11%) on average, with a rapid rise in TST positivity up to 10 years of work and then a plateau with around 80% positive. Discussion A high proportion of HCWs had a history of TB or were TST positive, increasing with longer duration of work. A package of TB infection control measures is needed to protect HCWs from Mycobacterium tuberculosis infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mycobacterium tuberculosisinfection and disease in healthcare workers in a tertiary referral hospital in Bandung, Indonesia

Apriani

McAllister

Sharples

et al. 2022

Journal of Infection Prevention

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“…For comparison with the review by JOSHI et al [1], we restricted our analysis to studies from five countries (Brazil, India, South Africa, Thailand and Turkey) included in that review (six studies [100][101][102][103][104][105]) and our In HCSs, years spent in healthcare after entry to a clinical programme [28] and contact with a TB patient [59] were independent risk factors. [65,81], household contact with TB [47,81], smoking status [36,48], chronic disease [64,65], immunosuppression [24] and diabetes mellitus [64] were independent non-occupational risk factors in HCWs. Similarly in HCSs, male sex [54,59], BCG scar/history of BCG vaccination [53,54], older age [34], TB knowledge [34] and course of study [59] were associated with a higher LTBI prevalence.…”

Section: Prevalence Of Ltbi Measured By Tst and Igramentioning

confidence: 99%

Latent tuberculosis infection in healthcare workers in low- and middle-income countries: an updated systematic review

et al. 2019

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Healthcare workers (HCWs) are at increased risk of latent tuberculosis (TB) infection (LTBI) and TB disease.We conducted an updated systematic review of the prevalence and incidence of LTBI in HCWs in low- and middle-income countries (LMICs), associated factors, and infection control practices. We searched MEDLINE, Embase and Web of Science (January 1, 2005–June 20, 2017) for studies published in any language. We obtained pooled estimates using random effects methods and investigated heterogeneity using meta-regression.85 studies (32 630 subjects) were included from 26 LMICs. Prevalence of a positive tuberculin skin test (TST) was 14–98% (mean 49%); prevalence of a positive interferon-γ release assay (IGRA) was 9–86% (mean 39%). Countries with TB incidence ≥300 per 100 000 had the highest prevalence (TST: pooled estimate 55%, 95% CI 41–69%; IGRA: pooled estimate 56%, 95% CI 39–73%). Annual incidence estimated from the TST was 1–38% (mean 17%); annual incidence estimated from the IGRA was 10–30% (mean 18%). The prevalence and incidence of a positive test was associated with years of work, work location, TB contact and job category. Only 15 studies reported on infection control measures in healthcare facilities, with limited implementation.HCWs in LMICs in high TB incidence settings remain at increased risk of acquiring LTBI. There is an urgent need for robust implementation of infection control measures.

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“…These findings indicate increased workplace exposure to mycobacterium tuberculosis despite existing guidelines on the prevention of TB among HCWs [ 6 ]. A study conducted in a tertiary hospital in Malaysia using TST showed a prevalence of 50% among HCWs, which was comparatively higher than a past study among a similar population using IGRA which showed a prevalence of LTBI of only 10.6% [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 74%

Facilitators and barriers to latent tuberculosis infection treatment among primary healthcare workers in Malaysia: a qualitative study

H.,

Manoharan,

Koh

et al. 2023

BMC Health Serv Res

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Background Healthcare workers (HCWs) have an increased risk of active and latent tuberculosis infection (LTBI) compared to the general population. Despite existing guidelines on the prevention and management of LTBI, little is known about why HCWs who tested positive for LTBI refuse treatment. This qualitative study sought to explore the facilitators and barriers to LBTI treatment uptake among primary HCWs in Malaysia. Methods This qualitative study used a phenomenological research design and was conducted from July 2019 to January 2021. A semi-structured topic guide was developed based on literature and the Common-Sense Model of Self-Regulation. We conducted one focus group discussion and 15 in-depth interviews with primary care HCWs. Interviewees were 7 physicians and 11 allied HCWs who tested positive for LTBI by Tuberculin Skin Test or Interferon Gamma Release Assay. Audio recordings were transcribed verbatim and thematic analysis was used to analyse the data. Results We found four factors that serve as barriers to HCWs’ LTBI treatment uptake. Uncertainties about the need for LTBI treatment, alongside several other factors including the attitude of the treating physician towards treatment, time constraints during clinical consultations, and concerns about the treatment itself. On the other hand, facilitators for LTBI treatment uptake can be grouped into two themes: diagnostic modalities and improving knowledge of LTBI treatment. Conclusions Improving HCWs’ knowledge and informative clinical consultation on LTBI and its treatment benefit, aided with a definitive diagnostic test can facilitate treatment uptake. Additionally, there is a need to improve infection control measures at the workplace to protect HCWs. Utilizing behavioural insights can help modify risk perception among HCWs and promote treatment uptake.

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Not Tb-proof: latent tuberculosis in Kuala Lumpur Hospital health care workers

Cited by 4 publications

References 5 publications

Mycobacterium tuberculosisinfection and disease in healthcare workers in a tertiary referral hospital in Bandung, Indonesia

Mycobacterium tuberculosisinfection and disease in healthcare workers in a tertiary referral hospital in Bandung, Indonesia

Latent tuberculosis infection in healthcare workers in low- and middle-income countries: an updated systematic review

Facilitators and barriers to latent tuberculosis infection treatment among primary healthcare workers in Malaysia: a qualitative study

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