Job-Related Risk of Latent Tuberculosis Infection in a Homogeneous Population of Hospital Workers in a Low Incidence Area

Occupational Safety and Health Unit, Azienda USL-Bologna Sud, Bologna, Italy.
American Journal of Industrial Medicine (Impact Factor: 1.74). 04/2009; 52(4):297-303. DOI: 10.1002/ajim.20680
Source: PubMed


Few comprehensive tuberculin surveys were carried out in a homogeneous population of health care workers (HCWs) in a low incidence area to assess the risk of tuberculosis (TB) infection by different occupational groups and units.
Community and occupational factors and tuberculin skin test (TST) reactivity were determined in 1,755 HCWs.
The overall prevalence of tuberculin reactivity was 6%. Predicting factors for TST reactivity were age >47 years (OR = 2.88), history of household TB contact (OR = 2.41), years of work as HCW (OR = 2.57), physician (OR = 1.88), and working in microbiology (OR = 4.94), dialysis/nephrology (OR = 2.00), gynecology/obstetrics (OR = 2.01). In a multiple regression model working in microbiology [OR = 4.16 (1.27-13.6)], dialysis/nephrology [OR = 2.52 (1.36-4.65)], gynecology/obstetrics [OR = 2.46 (1.24-4.86)] and age >47 years [OR = 1.98 (1.14-3.46)] were significant predictors for infection.
A higher risk of latent infection can be demonstrated in well-defined groups of HCWs.

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    • "One was a study with a homogeneous population of healthcare workers in a low-incidence area in Italy. Franchi and colleagues [37] found a low prevalence rate (6%). Working in microbiology (OR 4.16, 95% CI 1.27-13.6), "
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    ABSTRACT: Healthcare workers are still recognised as a high-risk group for latent TB infection (LTBI). Therefore, the screening of people employed in the healthcare sector for active and LTBI is fundamental to infection control programmes in German hospitals. It was the aim of the study to determine the prevalence and putative risk factors of LTBI. We tested 2028 employees in the healthcare sector with the QuantiFERON-Gold In-tube (QFT-IT) test between December 2005 and May 2009, either in the course of contact tracing or in serial testing of TB high-risk groups following German OSH legislation. A positive IGRA was found in 9.9% of the healthcare workers (HCWs). Nurses and physicians showed similar prevalence rates (9.7% to 9.6%). Analysed by occupational group, the highest prevalence was found in administration staff and ancillary nursing staff (17.4% and 16.7%). None of the individuals in the trainee group showed a positive IGRA result. In the different workplaces the observed prevalence was 14.7% in administration, 12.0% in geriatric care, 14.2% in technicians (radiology, laboratory and pathology), 6.5% in admission ward staff and 8.3% in the staff of pulmonary/infectious disease wards. Putative risk factors for LTBI were age (>55 years: OR14.7, 95% CI 5.1-42.1), being foreign-born (OR 1.99, 95% CI 1.4-2.8), TB in the individual's own history (OR 4.96, 95% CI 1.99-12.3) and previous positive TST results (OR 3.5, 95% CI 2.4-4.98). We observed no statistically significant association with gender, BCG vaccination, workplace or profession. The prevalence of LTBI in low-incidence countries depends on age. We found no positive IGRA results among trainees in the healthcare sector. Incidence studies are needed to assess the infection risk. Pre-employment screening might be helpful in this endeavour.
    Full-text · Article · Apr 2010 · BMC Infectious Diseases
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    • "By using the interferon-gamma release assay (IGRA) in another study by Nienhaus, (2009) (8) LTBI prevalence in HCWs was 10 %, and this study recommended that prevention strategies in Germany should be reconsidered. On studying 1755 Italian HCWs, Franchi et al., in 2009 (9) "
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    ABSTRACT: Tuberculosis (TB) infection represents a global health problem and a great risk to Health Care Workers (HCWs). Identifying individuals, particularly HCWs with latent tuberculosis infection (LTBI) will support TB control through chemoprophylaxis and prevent cross-infection. This study aimed to identify prevalence of Latent TB among a two-year new hires of HCWs in 4 major tertiary care hospitals in Riyadh, Saudi Arabia. 2650 recently (2-years) hired HCWs were surveyed for latent TB using Tuberculin Skin Test (TST). Data was collected from January 2008 to December 2009. Induration due to TST equal to or more than 10 mm. within 48-72 hours was considered positive. The results of TST were correlated with other variables such as age group, gender, job category, country of origin. as an overall rate, 291(11%) out of 2650 were positive for TST, with the highest significant positive rates among physicians (14.9%) and nurses (12.9%) compared to students as a reference group. No statistically significant difference was detected between both sexes. The highest significant positive TST rates were found among HCWs in the age group of 50 years and older (32.6%) compared to 10-19 years age group as a reference group, and among HCWs coming from sub-Saharan countries (61.1%) compared to Saudi HCWs with the lowest positive rates (5%) as a reference group. Conclusion and recommendations: LTB is prevalent among newly hired HCWs in Riyadh tertiary hospitals. Standard programs for detection and treatment of LTB should be encouraged.
    Full-text · Article · Jan 2010 · The Journal of the Egyptian Public Health Association
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    ABSTRACT: The Italian National Vaccination Plan 2005-2007 strongly recommends that healthcare workers (HCWs) be offered hepatitis B and influenza vaccines and that susceptible workers should also be offered measles, mumps, rubella and varicella vaccines. Nationwide figures for vaccination coverage among HCWs are not currently available. Vaccination coverage is high but not yet satisfactory for hepatitis B and is absolutely insufficient for influenza. Susceptibility rates to childhood exanthematic diseases are low: when attempting to achieve complete immunity, screening the individuals at recruitment is cost effective. The procedures for TB prevention are a consolidated practice for occupational health physicians. Hospital health directors should be empowered on the importance of vaccinating HCWs as a milestone of hospital risk management. More adequate training, including specific courses on vaccinations, is required for occupational health physicians.
    No preview · Article · Mar 2010 · Expert Review of Vaccines
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