Tuberkulose im Gesundheitswesen

Abstract

Perception and knowledge of the TB-infection risk in healthcare workers (HCWs) changed profoundly in Germany during the past few years. Molecular-epidemiological studies and a comprehensive review of the existing evidence concerning the infection risk for HCWs lead to the conclusion that TB in HCWs is often caused by infection at the workplace. In the Hamburg Fingerprint Study, 80 % of the TB cases in HCWs were caused by infections at the workplace. In a similar Dutch study 43 % of all cases were work-related. Besides of the well-known risks in TB wards and laboratories, an increased risk for infection should be assumed for paramedics, in emergency rooms, for HCWs caring for the elderly or for workers with close contact to high-risk groups (homeless people, i. v. drug users, migrants from high-incidence countries). TB in a HCW working in these fields can be recognised as an occupational disease (OD) without identifying a particular source of infection. For all other HCWs, the German occupational disease law requires the identification of a source case before TB in an HCW can be accepted as an OD. Even though the proportion of work-related TB in HCWs is higher than was assumed before previously, the prevalence of latent TB infection (LTBI) is lower than expected. In an ongoing evaluation study of the interferon-gamma release assay (IGRA) LTBI prevalence in HCWs is 10 %. Prevention strategies in Germany should be reconsidered in the light of these new findings.