Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries-A Systematic Review and Meta-Analysis.

Claudia Peters,Agnessa Kozak,Albert Nienhaus,Anja Schablon

doi:10.3390/ijerph17020581

Abstract

Healthcare workers (HCWs) have increased risk for latent tuberculosis infection (LTBI) and tuberculosis (TB) disease due to their occupational exposure. For some years now, interferon-γ release assays (IGRAs) have replaced the tuberculin skin test for the diagnosis of LTBI in many countries. This review examined the occupational risk of LTBI in HCWs with IGRA testing in low incidence countries. A systematic review and meta-analysis of studies from 2005 onwards provide data regarding the prevalence of LTBI in HCWs. In addition, the pooled effect estimates were calculated for individual regions and occupational groups. 57 studies with 31,431 HCWs from four regions and a total of 25 countries were analysed. The prevalence of LTBI varied from 0.9 to 85.5%. The pooled estimation found the lowest prevalence of LTBI for North American and West Pacific countries (<5%), and the highest prevalence for Eastern Mediterranean countries (19.4%). An increased risk for LTBI was found only for administrative employees. Studies on the occupational risk of LTBI continue to show increased prevalence of HCWs, even in low-incidence countries. Good quality studies will continue to be needed to describe occupational exposure.

Highlights

Healthcare workers (HCWs) have an elevated risk of latent tuberculosis infection (LTBI) and TB disease (tuberculosis (TB)) due to the nature of their jobs [1,2,3,4]
How high is the prevalence of LTBI among healthcare workers in low-incidence countries, measured using IGRAs?
Most common was no medical studywere: population or the covered study took placeinvestigations in high-incidence countries; there was no reasons for exclusion publications contact following there use tests or itspopulation use was only to study confirm a positive or, the exclusion wasthere due to the wasof noIGRA

Summary

Introduction

Healthcare workers (HCWs) have an elevated risk of latent tuberculosis infection (LTBI) and TB disease (tuberculosis (TB)) due to the nature of their jobs [1,2,3,4]. In Germany, where TB incidence is low, TB in healthcare workers remains one of the most common infections reported to the compensation board [7]. Most of the reviews of the TB infection risk among HCWs were conducted in low and middle-income countries [3,8,9,10]. The occupational infection risk and the probability of causation have primarily been analysed while using the tuberculin skin test (TST) after Mendel and Mantoux. Interferon-γ release assays (IGRAs) have been used to diagnose latent tuberculosis infection. Public Health 2020, 17, 581; doi:10.3390/ijerph17020581 www.mdpi.com/journal/ijerph

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