Table 10.
Tuberculosis among Healthcare Workers
| First Author, Year, Location (Reference) | Study Type | TB Definition/Diagnosis | Exposure/Job Information | Cases (n)/Control or Total Population (N) | Risk Estimate | Occupational Burden (%) |
|---|---|---|---|---|---|---|
| Rosenman, 1996, USA (209) | Case–control | Bacteriological or treatment reporting | SIC and SOC codes used as proxy for exposures | HIV-positive, foreign-born cases excluded; 149 cases from TB registry; 290 cancer referents | OR, 2.8 (95% CI, 1.4–5.7) | 8.2 |
| Raitio, 2000, Finland (203) | National register review | Bacteriologically, histologically, and/or clinically | All HCWs assessed for occupational TB, extracted from national register | 658 cases between 1966 and 1995 | IRR, 0.67 | 0 |
| Laraqui, 2001, Morocco (218) | Cross-sectional | Case notification | All HCWs notified by health services between 1994 and 1997 | 130 cases among 152,447 HCWs | IRR, 0.72 | 0 |
| Eyob, 2002, Ethiopia (204) | Cohort | Sputum culture or clinical or radiological findings | HCWs at a specialist TB center | 24 cases among 175 HCWs | IRR, 7.2* | 0.4 |
| Jiamjarasrangsi, 2005, Thailand (198) | Cohort | TB diagnoses in medical records database | Thai HCWs observed at a single hospital | 78 cases among 3,894 HCWs | IRR, 3.5 | 0.1 |
| Tam, 2006, Hong Kong (219) | National registry records review | Not stated | Surveillance data of occupational TB reported to the Labor Department | 141 cases among 57,869 HCWs over 5 yr | IRR, 0.5 | 0 |
| de Vries, 2006, Netherlands (200) | Records review | Restriction fragment length polymorphism typing (DNA fingerprinting) | Cases ‘‘working in the healthcare/social-welfare sector’’ from a national TB registry | 94 cases among 126,500 HCWs | IRR, 0.8 | 0 |
| Ong, 2006, USA (201) | Cohort study | TB reported to San Francisco Department of Public Health | All cases of TB reported over multiple years | 33 cases among HCWs among 2,510 cases reported | IRR, 1.2 | 1.0 |
| Pazin-Filho, 2008, Brazil (205) | Database review | Clinical, sputum | HCWs at a university hospital | 21 cases among HCWs | IRR, 2.6* nurse technicians | 1.4 |
| Roche, 2008, Australia (199) | Database review | Laboratory, clinical diagnosis of TB | HCWs recorded in National Notifiable Diseases Surveillance System | 65 cases among HCWs reported in 2006 | IRR, 2.1 | 4.0 |
| Costa, 2011, Portugal (206) | Cohort | Clinical, bacteriological, radiological | HCWs at the São João Hospital followed from 2005 to 2010 | 62 cases among 6,112 HCWs | IRR, 3.2 | 4.4 |
| Lambert, 2012, USA (202) | Database review | Review of National TB Surveillance System records | TB cases reported to the CDC | 6,049 cases among HCWs among the 200,774 cases | IRR, 0.8 | 0 |
| Tudor, 2014, South Africa (207) | Retrospective cohort | Based on records captured | HCWs in three hospitals with specialist MDR-TB wards | 112 cases among 1,313 HCW records reviewed | IRR, 2.0* | 1.3 |
| Toms, 2015, Australia (220) | National database review | National Notifiable Diseases Surveillance System | Working in a healthcare setting in the past 12 mo | 24 cases among HCWs in 2013 | IRR, 1.1 | 0.1 |
| Klimuk, 2014, Belarus (208) | Retrospective record review | Sputum smear, culture, drug susceptibility testing | Review of records from TB healthcare facilities | 116 cases among 5,441 HCWs | IRR, 5.4 | 8.9 |
| O’Hara, 2017, South Africa (222) | National database review | Laboratory-confirmed diagnosis | All HCWs in a particular province in South Africa | 2,677 cases of TB among 32,039 HCWs over 11-yr period | IRR, 1.14* | 1.2 |
| Davidson, 2017, UK (221) | National TB surveillance | Notified TB cases from surveillance database | HCW work information extracted from database | 2,320 cases of HCW TB between 2009 and 2013 | IRR, 1.5* | 2.8 |
Definition of abbreviations: CI = confidence interval; HCW = healthcare worker; IRR = incidence rate ratio; MDR-TB = multidrug-resistant tuberculosis; OR = odds ratio; SIC = Standard Industrial Classification; SOC = Standard Occupational Classification; TB = tuberculosis; UK = United Kingdom; USA = United States.
Except for one publication providing an OR, the occupational burden is estimated from an IRR either reported or derived from World Bank and World Health Organization data for the HCW labor force and national TB rates. The median HCW-associated burden of TB was 1.0% (range, 0.8–9%).
*
Author-reported IRR.