Abstract
Defining occupational latent tuberculosis infection (LTBI) risk among healthcare workers is needed to support implementation of prevention guidelines. Prospective cohort study of 200 medical residents and nursing students in India was conducted May 2016—December 2017. Tuberculin skin test (TST) and QuantiFERON TB Gold Test-in-tube (QFT-GIT) were performed at study entry and 12 months. Primary outcome was incident LTBI (≥10mm TST induration and/or ≥0.35IU/mL QFT-GIT) at 12 months; secondary outcomes included baseline LTBI prevalence and risk factors for incident and prevalent LTBI using Poisson regression. Among 200, [90 nursing students and 110 medical residents], LTBI prevalence was 30% (95% CI, 24–37); LTBI incidence was 26.8 (95% CI, 18.6–37.2) cases per 100 person-years and differed by testing method (28.7 [95% CI, 20.6–38.9] vs 17.4 [95% CI, 11.5–25.4] cases per 100 person-years using TST and QFT-GIT, respectively). Medical residents had two-fold greater risk of incident LTBI than nursing students (Relative Risk, 2.16; 95% CI, 1.05–4.42). During study period 6 (3%) HCWs were diagnosed with active TB disease. Overall, median number of self-reported TB exposures was 5 (Interquartile Range, 1–15). Of 60 participants with prevalent and incident LTBI who were offered free isoniazid preventive therapy (IPT), only 2 participants initiated and completed IPT. High risk for LTBI was noted among medical residents compared to nursing students. Self-reported TB exposure is underreported, and uptake of LTBI prevention therapy remains low. New approaches are needed to identify HCWs at highest risk for LTBI.
Highlights
Tuberculosis (TB) risk is elevated among health care workers (HCW) in low- and middleincome countries (LMIC) compared to the general population [1,2,3]
latent TB infection (LTBI) prevalence was 30% overall and higher among medical residents than nursing students, not statistically significant (35% [95% CI, 27–45] vs. 23% [95% CI, 15–33], p = 0.06) (S1 Table and Fig 1)
Prior exposure to sputum smear positive TB cases was associated with two-fold greater risk of prevalent LTBI than no history of TB exposure (Relative Risk [RR], 2.11; 95% CI, 1.04– 4.24)
Summary
Tuberculosis (TB) risk is elevated among health care workers (HCW) in low- and middleincome countries (LMIC) compared to the general population [1,2,3]. Medical residents have been found to be at higher risk for LTBI than other students in LMIC, indicating high TB disease exposure in the workplace [11,12,13]. Low awareness of and control over exposure to risk factors likely contribute to this risk, yet risk factors for LTBI are not well-defined, among healthcare workers in high TB burden countries. World Health Organization (WHO) guidelines are in place for infection control in LMIC [14, 15], precise LTBI estimates are unknown
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