TB among Health Care Workers | CDC EID

EID Journal Home > Volume 17, Number 3–March 2011

Volume 17, Number 3–March 2011
MEDSCAPE CME ACTIVITY
Tuberculosis among Health Care Workers

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at www.medscape.org/journal/eid; (4) view/print certificate.

Release date: February 25, 2011; Expiration date: February 25, 2012

Learning Objectives
Upon completion of this activity, participants will be able to:

•Describe the risk for health care workers (HCWs) of developing incident latent tuberculosis infection (LTBI)
•Describe the risk for HCWs of developing tuberculosis (TB) disease
•Describe TB infection control measures that may be effective in healthcare settings
Medscape CME Editor
Karen L. Foster, MA, Technical Writer-Editor, Emerging Infectious Diseases. Karen L. Foster, MA, has disclosed no relevant financial relationships.

Medscape CME Author
Laurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

Authors
Disclosures: Iacopo Baussano, MD, MSc, PhD, SpID; Brian Williams, PhD; Emanuele Pivetta, MD; Massimiliano Bugiani, MD; and Fabio Scano, MD, have disclosed no relevant financial relationships. Paul Nunn, MA, FRCP(UK), has disclosed the following relevant financial relationship: served as a speaker or a member of a speakers bureau for Howard Hughes Foundation.

EID Journal Home > Volume 17, Number 3–March 2011

Volume 17, Number 3–March 2011
Research
Tuberculosis among Health Care Workers
Iacopo Baussano, Paul Nunn, Brian Williams, Emanuele Pivetta, Massimiliano Bugiani, and Fabio Scano
Author affiliations: University "A. Avogadro," Novara, Italy (I. Baussano); Centro per la Prevenzione Oncologica–Piemonte, Novara (I. Baussano); Imperial College, London, UK (I. Baussano); World Health Organization, Geneva, Switzerland (P. Nunn, B. Williams, F. Scano); University of Turin, Turin, Italy (E. Pivetta); Centro per la Prevenzione Oncologica–Piemonte, Turin (E. Pivetta); and Regional Reference Centre for Tuberculosis Prevention, Turin (M. Bugiani)

Suggested citation for this article

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.

Transmission of tuberculosis (TB) in health care settings to both patients and health care workers (HCWs) has been reported from virtually every country of the world, regardless of local TB incidence. TB transmission occurs through droplet nuclei aerosolized by patients with infectious pulmonary TB and inhaled by other persons. Transmission is most likely to occur from unrecognized or inappropriately treated TB. The risk for transmission varies by setting, occupational group, local prevalence of TB, patient population, and effectiveness of TB infection control measures (1).


In resource-rich countries TB began to be recognized as an occupational hazard in the 1950s (2); since then, effective infection control measures have been implemented to reduce the risk for nosocomial TB (3). Poor implementation of infection control measures, the effects of the HIV epidemic on TB, and the emergence of multidrug-resistant (MDR) strains resulted in the reemergence of hospital-based transmission of TB and MDR TB in the early 1990s (2).

Most recently, the emergence of extensively drug-resistant (XDR) TB strains is posing a major public health threat in contexts characterized by a lack of proper infection control measures (4). Although the risk for latent TB infection (LTBI) and TB disease has generally been considered to be higher among HCWs than in the general population, some studies from countries with low TB incidence and others from countries with high TB incidence failed to show a higher estimated risk for TB among HCWs than among the corresponding local community.

We had 2 main objectives in conducting our study. First, by reviewing the literature, we assessed the rate of LTBI and relative risk and risk difference for the incidence of TB among HCWs worldwide, compared with the incidence of TB in the corresponding local general population. Second, we assessed the population-attributable fraction (PAF) (percentage) of TB in the general population associated with exposure to HCWs in their working settings.

full-text:
TB among Health Care Workers | CDC EID


Suggested Citation for this Article
Baussano I, Nunn P, Williams B, Pivetta E, Bugiani M, Scano F. Tuberculosis among health care workers. Emerg Infect Dis [serial on the Internet]. 2011 Mar [date cited]. http://www.cdc.gov/EID/content/17/3/488.htm

DOI: 10.3201/eid1703.100947


Comments to the Authors
Please use the form below to submit correspondence to the authors or contact them at the following address:

Iacopo Baussano, School of Public Health, Faculty of Medicine, Rm 512 (5th Floor), St Mary's Campus, Norfolk Place, London W2 1PG, UK; email: i.baussano06@imperial.ac.uk