Tuberculosis transmission from healthcare workers to patients and co-workers: a systematic literature review and meta-analysis

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.

Fig 1. PRISMA 2009 Flow Diagram.

Flowchart depicting methods for article inclusion and exclusion. Abbreviations: MTB = Mycobacterium tuberculosis; TB = Tuberculosis; LTBI = Latent Tuberculosis Infection; HCWs = Health Care Workers

Fig 2. Proportion meta-analysis (random effects).

Forest plots for: A. Proportion of active TB cases among infants; B. Proportion of active TB cases among children; C. Proportion of active TB cases among adult patients; D. Proportion of active TB cases among HCWs. (A B C D elements are ordered from top to bottom and left to right).

Fig 3. Proportion meta-analysis (random effects).

Forest plots for: A. Proportion of cases who acquired TB infection cases among infants; B. Proportion of acquired TB infection among children; C. Proportion of acquired TB infection among adult patients; D. Proportion of acquired TB infection among HCWs. (A B C D elements are ordered from top to bottom and left to right).