Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Morocco

Abstract

Increased prevalence of latent tuberculosis infection (LTBI) has been observed among high-risk populations such as healthcare workers (HCWs). The results may depend on the method of LTBI assessment, interferon-gamma release assay (IGRA) and/or tuberculin skin test (TST). Here, we investigated the prevalence and risk factors for LTBI assessed by both IGRAs and TST in HCWs living in Morocco, a country with intermediate tuberculosis (TB) endemicity and high BCG vaccination coverage. HCWs were recruited in two Moroccan hospitals, Rabat and Meknes. All the participants underwent testing for LTBI by both IGRA (QuantiFERON-TB Gold In-Tube, QFT-GIT) and TST. Different combinations of IGRA and TST results defined the LTBI status. Risk factors associated with LTBI were investigated using a mixed-effect logistic regression model. The prevalence of LTBI among 631 HCWs (age range 18–60 years) varied from 40.7% (95%CI 36.9–44.5%) with QFT-GIT to 52% (95%CI 48.2–56.0%) with TST using a 10 mm cut-off. The highest agreement between QFT-GIT and TST (κ = 0.50; 95%CI 0.43–0.56) was observed with the 10 mm cut-off for a positive TST. For a definition of LTBI status using a double positive result for both QFT-GIT and TST, significant associations were found with the following risk factors: being male (OR = 2.21; 95%CI 1.40–3.49; p = 0.0007), belonging to age groups 35–44 years (OR = 2.43; 95%CI 1.45–4.06; p = 0.0007) and even more 45–60 years (OR = 4.81; 95%CI 2.72–8.52; p = 7.10 −8 ), having a family history of TB (OR = 6.62; 95%CI 2.59–16.94; p = 8.10 −5 ), and working at a pulmonology unit (OR = 3.64; 95%CI 1.44–9.23; p = 0.006). Smoking was associated with LTBI status when defined by a positive QFT-GIT result (OR = 1.89; 95%CI 1.12–3.21; p = 0.02). A high prevalence of LTBI was observed among HCWs in two Moroccan hospitals. Male gender, increased age, family history of TB, and working at a pulmonology unit were consistent risk factors associated with LTBI.

<p>The Prevalence and Demographic Risk Factors for Latent Tuberculosis Infection (LTBI) Among Healthcare Workers in Semarang, Indonesia</p>

“…The healthcare workers who work in the pulmonary disease service units have a fourfold increased risk of LTBI compared to the non-clinical service units. 47 This is related to the characteristics of pulmonary TB, which is easily transmitted from its sufferers to others through the airway. 48 The results of the study showed that 23 (8.2%) respondents were smokers, and all were male.…”

Tuberculosis Infection Screening in 5468 Italian Healthcare Students: Investigation of a Borderline Zone Value for the QFT-Test

“…In particular, the borderline group was composed almost entirely of women. According to the literature, the male gender is a risk factor for active TB but this gender disparity has not been fully investigated for LTBI [ 37 ].…”

Factors Associated with Latent Tuberculosis Infection among the Hospital Employees in a Tertiary Hospital of Northeastern Thailand

“…According to some epidemiological studies, an increased risk of infection is related to activities that involve close contact with TB patients and work in which aerosol-generating procedures (AGPs) are used. Workplaces with AGP, work duration, room size, and priority of contact with TB were also reported to be related to LTBI [ 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Although medical activities are known to be a risk and ineffective prevention, poor immunity (i.e., lack of an adequate Bacille Calmette-Guérin (BCG) vaccine) is considered a greater risk for having LTBI [ 20 ].…”