Article

Tuberculosis among health care workers.

University A. Avogadro, Novara, Italy.
Emerging Infectious Diseases (impact factor: 6.79). 03/2011; 17(3):488-94. DOI:10.3201/eid1703.100947 pp.488-94
Source: PubMed

ABSTRACT To assess the annual risk for latent tuberculosis infection (LTBI) among health care workers (HCWs), the incidence rate ratio for tuberculosis (TB) among HCWs worldwide, and the population-attributable fraction of TB to exposure of HCWs in their work settings, we reviewed the literature. Stratified pooled estimates for the LTBI rate for countries with low (<50 cases/100,000 population), intermediate (50-100/100,000 population), and high (>100/100,000 population) TB incidence were 3.8% (95% confidence interval [CI] 3.0%-4.6%), 6.9% (95% CI 3.4%-10.3%), and 8.4% (95% CI 2.7%-14.0%), respectively. For TB, estimated incident rate ratios were 2.4 (95% CI 1.2-3.6), 2.4 (95% CI 1.0-3.8), and 3.7 (95% CI 2.9-4.5), respectively. Median estimated population-attributable fraction for TB was as high as 0.4%. HCWs are at higher than average risk for TB. Sound TB infection control measures should be implemented in all health care facilities with patients suspected of having infectious TB.

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    Article: Comparison of screening strategies to improve the diagnosis of latent tuberculosis infection in the HIV-positive population: a cohort study.
    Katrina M Pollock, Herman Tam, Lisa Grass, Sharleen Bowes, Graham S Cooke, Manish Pareek, Damien Montamat-Sicotte, Moses Kapembwa, Graham P Taylor, Ajit Lalvani
    [show abstract] [hide abstract]
    ABSTRACT: HIV is the most important risk factor for progression of latent tuberculosis infection (LTBI) to active tuberculosis (TB). Detection and treatment of LTBI is necessary to reduce the increasing burden of TB in the UK, but a unified LTBI screening approach has not been adopted. To compare the effectiveness of a TB risk-focused approach to LTBI screening in the HIV-positive population against current UK National Institute for Health and Clinical Excellence (NICE) guidance. Prospective cohort study. Two urban HIV treatment centres in London, UK. 114 HIV-infected individuals with defined TB risk factors were enrolled prospectively as part of ongoing studies into HIV and TB co-infection. The yield and case detection rate of LTBI cases within the research study were compared with those generated by the NICE criteria. 17/114 (14.9%, 95% CI 8.3 to 21.5) had evidence of LTBI. Limiting screening to those meeting NICE criteria for the general population (n=43) would have detected just over half of these, 9/43 (20.9%, 95% CI 8.3 to 33.5) and those meeting criteria for HIV co-infection (n=74) would only have captured 8/74(10.8%, 95% CI 3.6 to 18.1) cases. The case detection rates from the study and NICE approaches were not significantly different. LTBI was associated with the presence of multiple TB risk factors (p=0.002). Adoption of a TB risk-focused screening algorithm that does not use CD4 count stratification could prevent more cases of TB reactivation, without changing the case detection rate. These findings should be used to inform a large-scale study to create unified guidelines.
    BMJ open. 01/2012; 2(2):e000762.
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Keywords

annual risk
 
countries
 
HCWs
 
health care facilities
 
health care workers
 
incidence rate ratio
 
incident rate ratios
 
intermediate
 
latent tuberculosis infection
 
LTBI rate
 
population-attributable fraction
 
Sound TB infection control measures