Abstract
IntroductionThe risk of tuberculosis (TB) in healthcare workers (HCWs) is related to its incidence in the general population, and increased by the specific risk as a professional group. The prevalence of latent tuberculosis infection (LTBI) in HCWs in Portugal using the tuberculin skin test (TST) and the interferon-γ release assays (IGRA) was analyzed over a five-year period.MethodsA screening programme for LTBI in HCWs was conducted, with clinical evaluations, TST, IGRA, and chest radiography. Putative risk factors for LTBI were assessed by a standardised questionnaire.ResultsBetween September 2005 and June 2009, 5,414 HCWs were screened. The prevalence of LTBI was 55.2% and 25.9% using a TST ≥ 10 mm or an IGRA test result (QuantiFERON-TB Gold In-Tube) INF-γ ≥0.35 IU/mL as a criterion for LTBI, respectively. In 53 HCWs active TB was diagnosed. The number of HCWs with newly detected active TB decreased from 19 in the first year to 6 in 2008. Risk assessment was poorly related to TST diameter. However, physicians (1.7%) and nurses (1.0%) had the highest rates of active TB.ConclusionsLTBI and TB burden among HCWs in Portugal is high. The screening of these professionals to identify HCWs with LTBI is essential in order to offer preventive chemotherapy to those with a high risk of future progression to disease. Systematic screening had a positive impact on the rate of active TB in HCWs either by early case detection or by increasing the awareness of HCWs and therefore the precautions taken by them.
Highlights
The risk of tuberculosis (TB) in healthcare workers (HCWs) is related to its incidence in the general population, and increased by the specific risk as a professional group
Bacillus Calmet-Guérin (BCG) vaccination did not increase the probability of a large TST diameter, with 63.2% of those with a TST < 5 mm compared to 53.9% of those with a TST ≥ 15 mm having a record of BCG vaccination or a vaccination scar
Our descriptive data show that the TB burden among Portuguese HCWs is high with 53 out of 5,209 (1%) being diagnosed with active TB in the five-year period from 2005 to 2009
Summary
The risk of tuberculosis (TB) in healthcare workers (HCWs) is related to its incidence in the general population, and increased by the specific risk as a professional group. With the advent of antibiotics, many infectious diseases such as tuberculosis (TB) seemed well under control [1] This feeling of security led to an absence of investment in implementing preventive measures and of training and education for healthcare workers (HCWs) on the risk of nosocomial infections and occupational diseases [2]. The average rate of TB reported in the general population in Portugal is 29.4/ 100,000, which means that, despite the reduction observed in recent years, it still has the highest incidence in the EU excluding the countries of the 2004 enlargement [10]. Despite the mandatory notification of active TB, there are no official records in Portugal of the number of affected HCWs [11]
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