Tuberculosis in Healthcare Workers: A Molecular Epidemiologic Study in San Francisco

Ong, A.; Rudoy, Irina; Gonzalez, Leah C.; Creasman, Jennifer M.; Kawamura, L. Masae; Daley, Charles L.

doi:10.1086/504504

Cited by 17 publications

(12 citation statements)

References 17 publications

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“…The significant protection against this afforded by N95 respirators mirrors the same trend seen in our previous study for clinical outcomes (MacIntyre et al, 2011outcomes (MacIntyre et al, , 2013. Outbreaks of bacterial respiratory infection do occur in HCWs (Kleemola and Jokinen, 1992;Ong et al, 2006;Pascual et al, 2006). Therefore, the observed reduction in bacterial colonization may translate to clinical protection against infection.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of face masks and respirators in preventing upper respiratory tract bacterial colonization and co-infection in hospital healthcare workers

MacIntyre

Wang

Rahman

et al. 2014

Preventive Medicine

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Section: Discussionmentioning

confidence: 99%

Efficacy of face masks and respirators in preventing upper respiratory tract bacterial colonization and co-infection in hospital healthcare workers

MacIntyre

Wang

Rahman

et al. 2014

Preventive Medicine

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“…In 8/10 HCWs who developed TB the infection was a consequence of occupational exposure. Secondly, Ong et al found genotyping or epidemiological evidence of job-related transmission in at least 32% of HCWs [35]. And thirdly, de Vries and colleagues determined which TB cases among HCWs were caused by infections acquired at the workplace.…”

Section: Discussionmentioning

confidence: 99%

Risk of latent TB infection in individuals employed in the healthcare sector in Germany: a multicentre prevalence study

et al. 2010

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BackgroundHealthcare 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.MethodsWe 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.ResultsA 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.ConclusionThe 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.

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“…Rather, an appropriate infectious contact needs to be ascertained as probable by interviewing the members of the cluster. Three molecular epidemiology studies on the occupational risk of infection have been published so far [4,26,27]. …”

Section: Introductionmentioning

confidence: 99%

“…The most up-to-date molecular epidemiology study on the occupational infection risk included all TB cases reported in San Francisco from 1993 to 2003 [27]. In all, there were 2,510 TB cases.…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis in healthcare workers – a narrative review from a German perspective

Nienhaus

Schablon

Preisser

et al. 2014

Journal of Occupational Medicine and Toxicology

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IntroductionDespite the decline of tuberculosis in the population at large, healthcare workers (HCW) are still at risk of infection.MethodsIn a narrative review the TB risk in HCW and preventive measures are described, with the focus on epidemiology and Occupational Safety and Health (OSH) regulations in Germany.ResultsThere is an increased risk of infection not only in pneumology and laboratories with regular contact with tuberculosis patients or infectious materials. Epidemiological studies have also verified an increased risk of infection from activities that involve close contact with patients’ breath (e.g. bronchoscopy, intubation) or close contact with patients in need of care in geriatric medicine or geriatric nursing. In occupational disease claim proceedings on account of tuberculosis, the burden of proof can be eased for insured persons who work in these or other comparable fields. Forgoing evidence of an index person as a source of infection has led to a doubling of the rate of cases of tuberculosis recognised as an occupational disease and has halved the duration of occupational disease claim proceedings in Germany. For several years now, it has been possible to use the new interferon-y release assays (IGRAs) to diagnose a latent tuberculosis infection (LTBI) with significantly greater validity than with the traditional tuberculin skin test (TST). However, variability of the IGRAs around the cut-off poses problems especially in serial testing of HCWs. At around 10%, LTBI prevalence in German healthcare workers is lower than had been assumed. It can make sense to treat a recent LTBI in a young healthcare worker so as to prevent progression into active tuberculosis. If the LTBI is occupational in origin, the provider of statutory accident insurance can cover the costs of preventive treatment. However, little is known about disease progression in HCWs with positive IGRA sofar.ConclusionTB screening in HCWs will remain an important issue in the near future even in low incidence, high income countries, as active TB in HCWs is often due to workplace exposure. The IGRAs facilitate these screenings. However, variability of IGRA results in serial testing of HCWs need further investigations.

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Tuberculosis in Healthcare Workers: A Molecular Epidemiologic Study in San Francisco

Cited by 17 publications

References 17 publications

Efficacy of face masks and respirators in preventing upper respiratory tract bacterial colonization and co-infection in hospital healthcare workers

Efficacy of face masks and respirators in preventing upper respiratory tract bacterial colonization and co-infection in hospital healthcare workers

Risk of latent TB infection in individuals employed in the healthcare sector in Germany: a multicentre prevalence study

Tuberculosis in healthcare workers – a narrative review from a German perspective

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