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. 2017 Aug 29;4(3):ofx137.
doi: 10.1093/ofid/ofx137. eCollection 2017 Summer.

Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis

Lydia Uden  1 , Ella Barber  1   2 , Nathan Ford  3 , Graham S Cooke  1
Affiliations

Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis

Lydia Uden et al. Open Forum Infect Dis. .

Abstract

Background: Tuberculosis (TB) remains a major challenge to global health. Healthcare workers (HCWs) appear to be at increased risk of TB compared with the general population, despite efforts to scale up infection control and reduce nosocomial TB transmission. This review aims to provide an updated estimate of the occupational risk of latent TB infection (LTBI) and active TB among HCWs compared with the general population.

Methods: A systematic review was performed to identify studies published over the last 10 years reporting TB prevalence or incidence among HCWs and a control group. Pooled effect estimates were calculated to determine the risk of infection.

Results: Twenty-one studies met the inclusion criteria, providing data on 30961 HCWs across 16 countries. Prevalence of LTBI among HCWs was 37%, and mean incidence rate of active TB was 97/100000 per year. Compared with the general population, the risk of LTBI was greater for HCWs (odds ratio [OR], 2.27; 95% confidence interval [CI], 1.61-3.20), and the incidence rate ratio for active TB was 2.94 (95% CI, 1.67-5.19). Comparing tuberculin skin test and interferon-gamma release assay, OR for LTBI was found to be 1.72 and 5.61, respectively.

Conclusions: The overall risk of both LTBI and TB to HCWs continues to be significantly higher than that of the general population, consistent with previous findings. This study highlights the continuing need for improvements in infection control and HCW screening programs.

Keywords: healthcare workers; incidence; occupational risk; prevalence; tuberculosis.

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Figures

Figure 1.
Figure 1.
Flow diagram illustrating literature search and study selection. Abbreviation: TB, tuberculosis.
Figure 2.
Figure 2.
Forest plot showing pooled odds ratio (OR) for latent tuberculosis infection among healthcare workers (HCWs). Abbreviation: CI, confidence interval.
Figure 3.
Figure 3.
Forest plot showing pooled incidence rate ratio (IRR) for active tuberculosis among healthcare workers (HCWs). Abbreviation: CI, confidence interval.
See this image and copyright information in PMC

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