Abstract
BackgroundThe risk of transmission of Mycobacterium tuberculosis from patients to health-care workers (HCWs) is a neglected problem in many low- and middle-income countries (LMICs). Most health-care facilities in these countries lack resources to prevent nosocomial transmission of tuberculosis (TB).Methods and FindingsWe conducted a systematic review to summarize the evidence on the incidence and prevalence of latent TB infection (LTBI) and disease among HCWs in LMICs, and to evaluate the impact of various preventive strategies that have been attempted. To identify relevant studies, we searched electronic databases and journals, and contacted experts in the field. We identified 42 articles, consisting of 51 studies, and extracted data on incidence, prevalence, and risk factors for LTBI and disease among HCWs. The prevalence of LTBI among HCWs was, on average, 54% (range 33% to 79%). Estimates of the annual risk of LTBI ranged from 0.5% to 14.3%, and the annual incidence of TB disease in HCWs ranged from 69 to 5,780 per 100,000. The attributable risk for TB disease in HCWs, compared to the risk in the general population, ranged from 25 to 5,361 per 100,000 per year. A higher risk of acquiring TB disease was associated with certain work locations (inpatient TB facility, laboratory, internal medicine, and emergency facilities) and occupational categories (radiology technicians, patient attendants, nurses, ward attendants, paramedics, and clinical officers).ConclusionsIn summary, our review demonstrates that TB is a significant occupational problem among HCWs in LMICs. Available evidence reinforces the need to design and implement simple, effective, and affordable TB infection-control programs in health-care facilities in these countries.
Highlights
The risk of transmission of Mycobacterium tuberculosis from individuals with tuberculosis (TB) to other patients and to health-care workers (HCWs) has been recognized for many years [1,2]
Our review demonstrates that TB is a significant occupational problem among HCWs in low- and middle-income country (LMIC)
We addressed the following questions: (1) What is the prevalence of latent TB infection (LTBI) and what are the risk factors for LTBI in HCWs? (2) What is the incidence of LTBI in HCWs and what risk factors are associated with higher incidence rates? (3) What is the incidence of TB disease in HCWs and how does it compare with the incidence in the population? (4) Are certain occupations, or some work locations within a health-care facility, at higher risk of TB than others? (5) How effective are various strategies in reducing the incidence of LTBI and/or disease among HCWs in LMICs?
Summary
The risk of transmission of Mycobacterium tuberculosis from individuals with tuberculosis (TB) to other patients and to health-care workers (HCWs) has been recognized for many years [1,2]. In the United States and other high-income countries, the risk of nosocomial transmission of TB was high in the pre-chemotherapy era, but declined with the reduction in incidence of TB disease in the population [3] This trend, changed between 1985 and 1993, when several outbreaks of multidrugresistant tuberculosis (MDR-TB) were reported in nosocomial and congregate settings in the United States [5,6]. Respiratory-protection controls (for example, personal respirators for nursing staff) aim to reduce the risk of infection when exposure to M. tuberculosis is unavoidably high. Together, these three layers of control have reduced the incidence of TB in HCWs (the number who catch TB annually) in high-income countries
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