Abstract
BackgroundNurses in developing countries are frequently exposed to infectious tuberculosis (TB) patients, and have a high prevalence of TB infection. To estimate the incidence of new TB infection, we recruited a cohort of young nursing trainees at the Christian Medical College in Southern India. Annual tuberculin skin testing (TST) was conducted to assess the annual risk of TB infection (ARTI) in this cohort.Methodology/Principal Findings436 nursing students completed baseline two-step TST testing in 2007 and 217 were TST-negative and therefore eligible for repeat testing in 2008. 181 subjects completed a detailed questionnaire on exposure to tuberculosis from workplace and social contacts. A physician verified the questionnaire and clinical log book and screened the subjects for symptoms of active TB. The majority of nursing students (96.7%) were females, almost 84% were under 22 years of age, and 80% had BCG scars. Among those students who underwent repeat testing in 2008, 14 had TST conversions using the ATS/CDC/IDSA conversion definition of 10 mm or greater increase over baseline. The ARTI was therefore estimated as 7.8% (95%CI: 4.3–12.8%). This was significantly higher than the national average ARTI of 1.5%. Sputum collection and caring for pulmonary TB patients were both high risk activities that were associated with TST conversions in this young nursing cohort.ConclusionsOur study showed a high ARTI among young nursing trainees, substantially higher than that seen in the general Indian population. Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement internationally recommended TB infection control interventions to protect its health care workforce.
Highlights
Tuberculosis (TB) continues to be a global killer, with over 9 million new cases of active disease diagnosed every year.[1]
Our study showed a high annual risk of TB infection (ARTI) among young nursing trainees, substantially higher than that seen in the general Indian population
Health care workers (HCW) serve on the front lines of the battle against TB, and the risk of infection among HCWs is especially high. [2,3] In a systematic review of studies from low and middle income countries, the annual risk of TB infection (LTBI) was found to vary between 0.5% to 14.3% in HCWs, while the annual incidence of TB disease ranged from 69–5,780 cases per 100 000 HCWs.[2]
Summary
Tuberculosis (TB) continues to be a global killer, with over 9 million new cases of active disease diagnosed every year.[1] Health care workers (HCW) serve on the front lines of the battle against TB, and the risk of infection among HCWs is especially high. HCWs in high TB burden settings are at higher risk of developing LTBI, compared with the general population, because of their exposure to large numbers of smear-positive TB cases managed at hospitals or health care centers. [5] the annual risk of TB infection (ARTI) among medical and nursing trainees was found to be 5%, 3 times higher than the 1.5% estimated ARTI for the general population in India. To estimate the incidence of new TB infection, we recruited a cohort of young nursing trainees at the Christian Medical College in Southern India. Annual tuberculin skin testing (TST) was conducted to assess the annual risk of TB infection (ARTI) in this cohort
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