Abstract
BackgroundHealth-care workers (HCWs) are an epidemiological group with increased exposure to tuberculosis (TB), especially at health-care facilities (HCFs) with poor TB infection control in high-TB-burden settings. China is a high-TB-burden country, and the comprehensive measures for stopping TB transmission at some HCFs were not implemented well owing to limited resources and other factors. The purpose of this study was to review risk of occupational exposure to TB among HCWs and its change trend, and identify epidemiological characteristics of pulmonary tuberculosis (PTB) among HCWs in Henan, central part of China.MethodsA retrospective cohort study was conducted from 2010 to 2017. All HCWs and teachers in Henan were enrolled to the study as exposed group and non-exposed control group, respectively. Relative risk (RR), attributable risk (AR) and AR percent (AR%) were used to measure the association between the occupational exposure and PTB, and estimated with Poisson regression.ResultsThe study results showed a total of 1663 cases of PTB were reported among the HCWs in Henan, accounting for 3.2‰ of all PTB cases reported in the whole population, and annual incidence rate of PTB among HCWs declined by 34% from 2010 to 2017. Over the eight years, the incidence rate of PTB among HCWs was 43.7 cases per 100,000 person-years (PYs), significantly higher than that among teachers (18.8 cases/100,000 PYs), and RR, AR and AR% were estimated to 2.3, 24.9 cases per 100,000 PYs and 57%, respectively. Among HCWs, males were more likely to suffer from PTB than females (adjusted RR: 1.3; 95%CI: 1.2–1.4), and HCWs aged under 25 years had the highest relative risk over all age groups with adjusted RR equaling to 8.3 (95%CI: 6.9-9.9) calculated with those aged 45–54 years as the reference.ConclusionsAlthough overall incidence rate of PTB among HCWs showed decreasing temporal trends over the period of 2010–2017, attributable risk of occupational exposure to TB among HCWs did not decrease in Henan, and TB infection at HCFs for males, young or senior HCWs, especially for young HCWs is of much concern.
Highlights
Health-care workers (HCWs) are an epidemiological group with increased exposure to tuberculosis (TB), especially at health-care facilities (HCFs) with poor TB infection control in high-TB-burden settings
HCWs are an epidemiological group with increased exposure to TB whether in low- or high-TB-burden settings, but the risk increase is much higher at health-care facilities (HCFs) with poor TB infection control in highTB-burden settings [4,5,6,7,8]
Incidence rates and Relative risk (RR) of pulmonary tuberculosis (PTB) among HCWs by year In total, 1663 cases of PTB diseases were diagnosed and reported among HCWs in Henan over the periods from 2010 to 2017, accounting for 3.2‰ (1663/511699) of all PTB cases reported in the whole population
Summary
Health-care workers (HCWs) are an epidemiological group with increased exposure to tuberculosis (TB), especially at health-care facilities (HCFs) with poor TB infection control in high-TB-burden settings. HCWs are an epidemiological group with increased exposure to TB whether in low- or high-TB-burden settings, but the risk increase is much higher at health-care facilities (HCFs) with poor TB infection control in highTB-burden settings [4,5,6,7,8]. TB transmission at HCFs can be effectively reduced as long as comprehensive measures are taken, including managerial and administrative controls, environmental controls and use of personal protective equipment [12, 13] These measures were not implemented well in developing countries owing to limited resources and other factors [5,6,7, 14]. Henan was included in this survey and such results reflected the status of Henan to a certain degree
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