Risk Analysis of Latent Tuberculosis Infection among Health Workers Compared to Employees in Other Sectors

Abstract

Latent tuberculosis infection (LTBI) represents a work-related risk for health workers (HWs). Tuberculosis remains the second most common occupational infectious disease among HWs in Germany. Comparative figures on LTBI prevalence in the general population are missing because testing is only carried out in the context of an outbreak situation. The objective of this study is to investigate whether HWs are at greater risk of LTBI than workers in other sectors. This study is based on two samples. The first sample is a database of HWs who were examined by the German Occupational Physicians Network using an interferon-gamma release assay (IGRA). The second sample consists of general employees (non-health workers, non-HWs) from Hamburg who had no professional contact with the health care system. Propensity score matching (PS matching) was performed to ensure better comparability of the groups. The differences in the prevalence of positive test results from IGRAs were examined using univariate and multivariate analyses. After the PS matching of 1:10, 100 test subjects in the non-HW group and 1000 HWs remained to form the analysis collective. The HWs tended to exhibit higher IGRA values than non-HWs. The univariate analysis showed an odds ratio (OR) of 3.86 for the HWs (95% confidence interval (CI): 0.99 to 32.5; p = 0.056) with respect to a positive test result. The multivariate analysis produced an OR of 4.92, (95% CI: 1.3 to 43.7; p = 0.013) for HWs born in Germany. Despite the declining tuberculosis incidence rates in Germany, a comparison with non-exposed professional groups showed that HWs are at greater risk of LTBI. Preventive medical check-ups still seem to be indicated.

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

“…Health workers (HW) are at greater risk of infection compared to non-medical occupational groups due to their occupational exposure to tuberculosis (TB) [ 1 ]. In Germany, the prevalence of Latent TB Infection (LTBI) among health workers is estimated to be around 10% based on examinations conducted in connection with preventative occupational medicine [ 2 , 3 ].…”

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“…A meta-analysis in low-incidence countries showed a pooled LTBI prevalence of 16.2% with a range from 0.9% to 85.5% for HCW in Europe [ 50 ]. Hermes et al [ 51 ] showed a prevalence of 7.2% in HCW in general compared to 2% in workers without a connection to healthcare, corresponding to an OR of 3.86. A study among dental students in Italy found a prevalence of 2.9% when they were tested with a tuberculin skin test (TST) and/or an interferon-y release assay (IGRA) [ 52 ].…”

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“…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].…”