Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries—A Systematic Review and Meta-Analysis

Peters, Claudia; Kozak, Agnessa; Nienhaus, Albert; Schablon, Anja

doi:10.3390/ijerph17020581

Cited by 21 publications

(19 citation statements)

References 65 publications

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“…Taking into account positive TST or IGRA results, the prevalence of infection found in this study was 31.4% and 12.5%, respectively. This prevalence is similar to that found in other studies carried out in Catalonia [17,18] and also in other studies that describe this data in countries of low and intermediate income [2,19,20]. Factors associated with the positivity of either TST or IGRA test were BCG vaccination status and degree of occupational exposure to tuberculosis.…”

Section: Plos Onesupporting

confidence: 91%

Serial testing of health care workers for tuberculosis infection: A prospective cohort study

et al. 2020

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Health Care Workers (HCW) may have an occupational risk of latent tuberculosis infection (LTBI) and TB disease. The objective of this study was to evaluate the performance of the 2step strategy: tuberculin skin test (TST) followed by confirmation with Interferon (IFN)-γrelease assays (IGRAs) in HCW. A secondary objective was to determine the factors related to conversions and reversions. HCW at risk of occupational exposure who attended the Occupational Department of the Hospital Germans Trias i Pujol were included during the study period (2013-2016). All professionals testing negative for LTBI were included in a cohort study. These workers were followed up with the administration of a TST and an IGRA quantification at least one year after inclusion in the study. Workers with positive TST, regardless of the results of the IGRA tests, were followed-up with an IGRA. 255 workers were enrolled in the study and 108 workers from the same cohort were followed up. During the follow-up period, seven workers presented TST test conversion. One of these conversions was also confirmed by an IGRA test. There were 2 conversions of cases only testing positive with the IGRA. There have been only 2 reversions of cases testing negative with the IGRA. In this study, not all TST conversions were confirmed when using the IGRA test, which highlights the importance of the 2-step strategy. We have detected a low number of conversions and reversions. Our conclusions should be confirmed in studies with a longer follow-up time.

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Section: Plos Onesupporting

confidence: 91%

Serial testing of health care workers for tuberculosis infection: A prospective cohort study

et al. 2020

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“…There has been a significant increase over the years. This increase may be explained by a number of causal factors, such as significant improvements in diagnostic instruments in terms of sensitivity and specificity, due to the IGRA test, particularly in detecting latent tuberculosis infection (LTBI) [15,[26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis among Health Workers—A Secondary Data Analysis of German Social Accident Insurance Data from 2002–2017

Kersten

Nienhaus

Schneider

et al. 2020

IJERPH

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Tuberculosis (TB) is the most common cause of fatal infections worldwide. Recent TB figures in Europe indicate that 30 people were infected with tuberculosis each hour in 2017. Healthcare workers are at particular risk of being infected through patient contact. TB is the second most common occupational infectious disease among German healthcare workers. Routine data from the German Social Accident Insurance were used to examine trends in occupational TB diseases. We analyzed annual cross-sectional data for the years 2002 to 2017. The data underwent descriptive analysis. A total of 4653 TB cases were recognized as occupational diseases (OD) in the period under study. In 2002, 60 TB cases were recognized as OD No. 3101, i.e., transmissions from person to person. Since 2013, the level has settled at around 500 recognized cases per year. This is around eight times the number of cases compared to 2002. The following three groups collectively accounted for the largest share of TB cases (88.5%): nurses (including geriatric nurses), other healthcare employees, and physicians. The upward trend in the number of TB cases recognized as occupational diseases is probably due to improvements in diagnostic tests used to diagnose TB infections. TB in health and welfare workers remains an important issue in the health and welfare sector in Germany, partly due to the long latency period between potential exposure to infectious patients or materials and the recognition of the latent tuberculosis infection (LTBI) or active TB as OD.

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“…Due to professional exposure, there has long been a scientific interest in analyzing LTBI among HWs. In a review, Peters et al studied the occupational risk of LTBI among medical personnel in low-incidence countries and found prevalence rates among HWs from 0.9% to 85.5% [ 1 ]. The values found in this study lie within the range of these widely distributed and regionally varying prevalences.…”

Section: Discussionmentioning

confidence: 99%

“…On the other side, Schablon et al [ 15 ] also found an astonishingly high rate of positive IGRA test results (14.2%) among subjects whose occupational group was summarized as “administrative”. Peters et al [ 1 ] also concluded that an “administrative” working area, comprising a heterogeneous group of employees in reception or management, increases the occupational risk of LTBI. For medical or nursing personnel, on the other hand, they identified no increased occupational risk of LTBI.…”

Section: Discussionmentioning

confidence: 99%

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

Hermes

Kersten

Nienhaus

et al. 2020

IJERPH

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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.

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Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries—A Systematic Review and Meta-Analysis

Cited by 21 publications

References 65 publications

Serial testing of health care workers for tuberculosis infection: A prospective cohort study

Serial testing of health care workers for tuberculosis infection: A prospective cohort study

Tuberculosis among Health Workers—A Secondary Data Analysis of German Social Accident Insurance Data from 2002–2017

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

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