Risk Analysis of Latent Tuberculosis Infection among Health Workers Compared to Employees in Other Sectors.

Lisa Hermes,Albert Nienhaus,Jan Felix Kersten,Anja Schablon

doi:10.3390/ijerph17134643

Abstract

Latent tuberculosis infection (LTBI) represents a work-related risk for health workers (HWs). Tuberculosis remains the second most common occupational infectious disease among HWs in Germany. Comparative figures on LTBI prevalence in the general population are missing because testing is only carried out in the context of an outbreak situation. The objective of this study is to investigate whether HWs are at greater risk of LTBI than workers in other sectors. This study is based on two samples. The first sample is a database of HWs who were examined by the German Occupational Physicians Network using an interferon-gamma release assay (IGRA). The second sample consists of general employees (non-health workers, non-HWs) from Hamburg who had no professional contact with the health care system. Propensity score matching (PS matching) was performed to ensure better comparability of the groups. The differences in the prevalence of positive test results from IGRAs were examined using univariate and multivariate analyses. After the PS matching of 1:10, 100 test subjects in the non-HW group and 1000 HWs remained to form the analysis collective. The HWs tended to exhibit higher IGRA values than non-HWs. The univariate analysis showed an odds ratio (OR) of 3.86 for the HWs (95% confidence interval (CI): 0.99 to 32.5; p = 0.056) with respect to a positive test result. The multivariate analysis produced an OR of 4.92, (95% CI: 1.3 to 43.7; p = 0.013) for HWs born in Germany. Despite the declining tuberculosis incidence rates in Germany, a comparison with non-exposed professional groups showed that HWs are at greater risk of LTBI. Preventive medical check-ups still seem to be indicated.

Highlights

Latent tuberculosis infection (LTBI) and active tuberculosis (TB) represent occupational risks in health care [1,2]
An analysis of persons born in countries at high risk of TB is presented in the supplement. We decided on this approach because we found an unusually high positive test result rate of 67% among the three subjects born in high-risk countries in the non-health workers (HWs) sample
This study shows that working in the health care sector entails a risk of TB infection

Summary

Introduction

Latent tuberculosis infection (LTBI) and active tuberculosis (TB) represent occupational risks in health care [1,2]. The risk of infection among health workers (HWs) has been described in numerous studies [2,3,4,5]. The reduction in TB incidence should correspond with a decrease in the risk of TB infection for HWs. an additional risk from working in health care seems to persist even in high-income countries with high hygiene standards [7,8]. Tuberculosis, as an occupational disease among HWs, is still the second most common recognized occupational disease [9]. TB screening is, performed for HWs in low-incidence countries, in order to

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