Prevalence of Latent Tuberculosis among Health Care Workers in High Burden Countries: A Systematic Review and Meta-Analysis

Abstract

BackgroundTuberculosis is one of the leading causes of death worldwide. Twenty-two high burden countries contributed to the majority of worldwide tuberculosis cases in 2015. Health care workers are at high risk of acquiring tuberculosis through occupational exposure.ObjectiveTo estimate the prevalence of latent tuberculosis infection (LTBI) among health care workers in high burden countries.MethodsDatabases including MEDLINE (Ovid), EMBASE (Ovid), CINAHL (Ovid) and ISI Web of Science (Thompson-Reuters), and grey literature were searched for English language records on relevant medical subject headings (MeSH) terms of LTBI and health care providers. Literature was systematically reviewed using EPPI-Reviewer4 software. Prevalence and incidence of LTBI and 95% confidence intervals (CI) were reported. Pooled prevalence of LTBI and 95% CI were calculated using random-effects meta-analysis models and heterogeneity was assessed using I2 statistics. Sub-group analysis was conducted to assess the cause of heterogeneity.ResultsA total of 990 records were identified. Of those, 18 studies from only 7 high burden countries representing 10,078 subjects were included. Tuberculin skin test results were available for 9,545 participants. The pooled prevalence of LTBI was 47% (95% CI 34% to 60%, I2 = 99.6%). In subgroup analyses according to the country of the study, the pooled prevalence of LTBI was lowest in Brazil (37%) and highest in South Africa (64%). The pooled prevalence of LTBI among medical and nursing students was 26% (95% CI 6% to 46%, I2 = 99.3%) while the prevalence among all types of health care workers was 57% (95% CI 44% to 70%, I2 = 99.1%). Incidence of LTBI was available for health care workers in four countries. The cumulative incidence ranged from 2.8% in Brazilian medical students to 38% among all types of health care workers in South Africa.ConclusionThe findings of this study suggest that there is a high burden of LTBI among health care workers in high burden countries. Adequate infection control measures are warranted to prevent and control transmission in health care settings.

A retrospective review of tuberculosis exposure among health care workers in a tertiary hospital

“…1 Previous studies have demonstrated that the overall prevalence of LTBI among HCWs was 37%, 2 ranging from 7.2%-14.9% in low-burden countries 5,6 to 47% in high-burden countries. 7 A review article by Menzies et al 4 reported that the median prevalence of LTBI was 63% (33%-79%) among HCWs in low-to middle-income countries, and 24% (4%-46%) among HCWs in highincome countries. Therefore, the baseline prevalence of LTBI among HCWs in our study reflects that in low-burden high-income countries.…”

Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis

“…The documented 3 to 6-fold increased risk of TB is due to persistent occupational TB exposure in the setting of absent or poorly implemented TB infection control (TB-IC) programmes 2,11 and a high prevalence of undiagnosed TB in healthcare facilities 22,23 . Ironically, accurate data on TB exposure and infection risk in HCWs is most limited from settings with highest TB burden 9,24 . Possible factors explaining the paucity of occupational TB data include the lack of national HCW TB surveillance, weak or non-existent occupational health programmes, reluctance among HCWs to disclose a TB diagnosis owing to stigma and the challenge of diagnosing latent TB infection in TB endemic settings 25 .…”

“…Certain risk factors that increase the likelihood of developing active TB have been identified such as HIV, diabetes and tobacco use. However, in other populations that include HCWs, who are more likely to have latent TB infection (LTBI) than the general population 24 , it is not possible to predict who will develop active TB. IPT or alternative LTBI treatment regimens have been recommended in high and low incidence settings for groups at high risk of TB reactivation, such as people living with HIV and contacts of patients with pulmonary TB 79 .…”

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

“…[2][3][4][5][6][7][8] A systematic review showed that the incidence of latent Mycobacterium tuberculosis infection (LTBI), demonstrated by converting the tuberculin skin test (TST), can reach 14% in these professionals; and the risk of developing TB disease is 5,361 cases/100,000 health workers every year due to nosocomial exposure. 9 In a multicenter been held in Brazil, identified a high prevalence of LTBI among health professionals in primary care through two diagnostic tests (TST and Interferon-gamma Release Assays-IGRA): 40% and 27%, respectively.…”

“…10 However, few studies explore this theme in other professions, either in Brazil or worldwide. 8,[11][12][13][14] It is necessary to verify the proportion of the disease among other occupational groups to determine the character of occupational TB.…”