Abstract
Healthcare workers (HCWs) are at risk of becoming infected with tuberculosis (TB), and potentially of being infectious themselves when they are ill. To assess the magnitude of healthcare-associated TB (HCA-TB) transmission from HCWs to patients and colleagues, we searched three electronic databases up to February 2014 to select primary studies on HCA-TB incidents in which a HCW was the index case and possibly exposed patients and co-workers were screened.We identified 34 studies out of 2,714 citations. In 29 individual investigations, active TB was diagnosed in 3/6,080 (0.05%) infants, 18/3,167 (0.57%) children, 1/3,600 (0.03%) adult patients and 0/2,407 HCWs. The quantitative analysis of 28 individual reports showed that combined proportions of active TB among exposed individuals were: 0.11% (95% CI 0.04–0.21) for infants, 0.38% (95% CI 0.01–1.60) for children, 0.09% (95% CI 0.02–0.22) for adults and 0.00% (95% CI 0.00–0.38) for HCWs. Combined proportions of individuals who acquired TB infection were: 0.57% (95% CI 7.28E-03 – 2.02) for infants, 0.9% (95% CI 0.40–1.60) for children, 4.32% (95% CI 1.43–8.67) for adults and 2.62% (95% CI 1.05–4.88) for HCWs. The risk of TB transmission from HCWs appears to be lower than that recorded in other settings or in the healthcare setting when the index case is not a HCW. To provide a firm evidence base for the screening strategies, more and better information is needed on the infectivity of the source cases, the actual exposure level of screened contacts, and the environmental characteristics of the healthcare setting.
Highlights
The transmission of tuberculosis (TB) in healthcare facilities is an important clinical and public health concern. [1, 2].Since the late 1980s, in the context of rising TB incidence rates in some low- and high-income countries, coupled with the increasing incidence of TB and human immunodeficiency virus (HIV) co-infection, and with the emergence of multidrug-resistant TB (MDR-TB), several major nosocomial TB outbreaks were reported and scientific interest on healthcare-associated transmission of Mycobacterium tuberculosis was re-stimulated [3,4,5,6,7]
The 34 articles included in this review reported information on a total of 117 healthcare-associated transmission of TB (HCA-TB) incidents
In the majority of studies, all individuals who were in the healthcare setting during the period of infectivity of the index case were considered as candidates for screening and no criteria for prioritisation were reported
Summary
The transmission of tuberculosis (TB) in healthcare facilities is an important clinical and public health concern. [1, 2]. Since the late 1980s, in the context of rising TB incidence rates in some low- and high-income countries, coupled with the increasing incidence of TB and human immunodeficiency virus (HIV) co-infection, and with the emergence of multidrug-resistant TB (MDR-TB), several major nosocomial TB outbreaks were reported and scientific interest on healthcare-associated transmission of Mycobacterium tuberculosis was re-stimulated [3,4,5,6,7]. These outbreaks were attributed to delayed diagnosis of infectious TB patients, unrecognized drug resistance and inadequate infection control measures. To assess and quantify the magnitude of the risk of transmission of M. tuberculosis from HCWs with pulmonary TB to patients and co-workers, in order to provide scientific evidence for policy development, we systematically reviewed HCA-TB incidents published to date
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