Tuberculosis among Healthcare Workers, United States, 1995–2007

Abstract

OBJECTIVE-We examined surveillance data to describe the epidemiology of tuberculosis (TB) among healthcare workers (HCWs) in the United States during the period 1995-2007.DESIGN-Cross-sectional descriptive analysis of existing surveillance data. CONCLUSIONS-Healthcare institutions may benefit from intensifying TB screening of HCWs upon hire, especially persons from countries with a high incidence of TB, and encouraging treatment for latent TB infection among HCWs to prevent progression to TB disease. SETTING AND PARTICIPANTS-TBSince the early 1990s, outbreaks of tuberculosis (TB) and multidrug-resistant TB in various medical settings have demonstrated patient-to-healthcare worker (HCW) transmission of Mycobacterium tuberculosis, 1-4 and other investigations have suggested that HCWs with untreated latent TB infection (LTBI) can later experience progression to TB disease, which can cause workplace exposure to patients and other HCWs. 5,6 The extent of occupational risk of TB for HCWs varies according to many factors, including prevalence of TB in the patient population, immunocompetency of the HCW, and effectiveness of infection control measures in the healthcare setting. 7 The objective of this analysis was to examine surveillance data and describe the epidemiology of TB among HCWs in the United States during the period 1995-2007.Address correspondence to Lauren Lambert, MPH, Centers for Disease Control and Prevention, 1600 Clifton Road, E-10, Atlanta, GA 30333 (lal0@cdc.gov). Potential conflicts of interest. All authors report no conflicts of interest relevant to this article. All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and the conflicts that the editors consider relevant to this article are disclosed here.The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the Centers for Disease Control and Prevention. HHS Public Access METHODSThis study describes new analyses of existing data routinely submitted to the Centers for Disease Control and Prevention through the National Tuberculosis Surveillance System. These data are collected for the purposes of disease surveillance and not human subject research that requires ethical institutional board review. TB cases were reported by the 50 states and the District of Columbia. Data were collected on a standardized form that included demographic, laboratory, clinical, and treatment outcome information.We Persons were considered to be foreign born if the reported country of birth was outside the United States or its jurisdictions in the Pacific and Caribbean. Method of TB treatment was recorded as (i) directly observed therapy (DOT), (ii) self-administered therapy, (iii) a combination of self-administered therapy and DOT, or (iv) unknown. DOT, an adherenceenhancing strategy in which a HCW or other trained person watches a patient swallow each dose of medication, is the standard care for all patients with TB disease and is a preferred option for patients treated for LTBI i...

The Occupational Burden of Nonmalignant Respiratory Diseases. An Official American Thoracic Society and European Respiratory Society Statement

“…As shown in Table 10, we found little consistency in estimates of the occupational burden of TB in HCWs. In five studies, the incidence rate among HCWs was lower than that of the general population (200,202,203,218,219), yielding an estimated burden of zero. Among those with an appreciable burden (IRR > 1), the occupational burden ranged from 0.1% (198) to 8.9% (198).…”

Cost-Effectiveness of Annual Screening for Tuberculosis among Italian Healthcare Workers: A Retrospective Study

“…In a recent meta-analysis, HCWs have been estimated to be both at high risk for active (A) and latent tuberculosis infection (LTBI) based on the results of epidemiological studies conducted in high and intermediate incidence countries [2]. A follow-up study carried out among a large number of North American hospital workers during the period 1995-2007 reported that TB incidence rates among HCWs were similar to those of the general population [6], foreign birth being the major risk factor of LTBI [7][8][9][10][11][12][13]. Moreover, a recent retrospective cohort study found an extremely low rate of Tuberculin Skin Test (TST) conversion among a large population of HCWs working in the low TB-incidence United States.…”

Cost Effectiveness of Preventive Treatment for Tuberculosis in Special High-Risk Populations

“…Recently, debate has opened in the US as to whether IGRAs should be used for repeated testing of HCWs as most annual conversions among HCWs in low TB-incidence settings appear to be false-positives [57,58]. Under that assumption, it has been questioned whether it would be justifiable to subject HCWs to annual testing [59,60], given the parallel observation that annual TST conversion rates are below 1 % in most US hospitals, where strong measures to limit nosocomial TB transmission have been in place [61]. However, the early analysis of Nettleman et al [48], which demonstrated cost effectiveness of annual screening, showed that an assumed annual conversion rate of only 0.4 % implies that 16.8 % of all physicians will become infected with MTB during their professional working lifetime.…”