Occupational Asthma Reference

Bhattacharya M, Gupta N, Vellore AD, Mukherjee R, Joshi TK, Burge PS, Prevalence of Tuberculosis in Health Care Workers in Delhi, Am J Respir Crit Care Med, 2008;177:A437,

Keywords: Healthcare workers, occupational tuberculosis

Known Authors

Sherwood Burge, Oasys Sherwood Burge

Arun Dev Vellore, Oasys Arun Dev Vellore

Rahul Mukherjee, Milton Keynes Hospital, UK Rahul Mukherjee

Neeraj Gupta, Maulana Azad Medical College, Delhi Neeraj Gupta

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Abstract

Background
The risk of Tuberculosis (TB) in Health Care Workers (HCWs) is not well established. While some believe it to be similar to that of the general population, some studies found a 2- to 6-fold increased risk. Two-thirds of the world’s population infected with TB reside in Asia but the data on risk of TB among HCWs in Asia is disproportionately scarce.

Methods
All 62 TB HCWs working in a large Indian urban teaching hospital (all employed for >1 year; 32 health visitors (TBHV) and 30 lab technicians (LT) preparing over 400 sputum smears a month) answered a questionnaire and were assessed clinically. Pre-employment TB vaccination status and Mantoux test results were recorded and point prevalence of pulmonary TB (June 2005) was estimated.

Results
One TBHV and 4 LTs were clinicoradiologically diagnosed with pulmonary TB. None of the cases had prior vaccination; all had a positive Mantoux test suggesting intact cell-mediated immunity; all were employed >6 years as a TB HCW; none were known domestic TB contacts. A higher occurrence of TB was found in LTs compared to TBHVs, in keeping with a previous Scottish study (Capewell S, Leaker AR, Leitch AG. Pulmonary tuberculosis in health service staff: is it still a problem? Tubercle 1988; 69:113–8.) but the z - test was not significant at 5% level of significance for the two proportions.

Discussion
TB HCWs working in countries with high TB prevalence appear to be at a high risk for TB disease. Routine annual chest radiographs have been shown to fail to identify 60% of new cases. We recommend tuberculin skin tests at periodic intervals for high risk HCWs in similar settings (an annual tuberculin skin test conversion rate of 3.96% and a significant linear relationship between acquisition of TB infection and HCW training duration has been previously demonstrated in the same institution in India). Further studies to determine screening frequency are necessary and interferon gamma based assays are likely to have a significant role, particularly in those prior vaccination.

Plain text: Background The risk of Tuberculosis (TB) in Health Care Workers (HCWs) is not well established. While some believe it to be similar to that of the general population, some studies found a 2- to 6-fold increased risk. Two-thirds of the world's population infected with TB reside in Asia but the data on risk of TB among HCWs in Asia is disproportionately scarce. Methods All 62 TB HCWs working in a large Indian urban teaching hospital (all employed for >1 year; 32 health visitors (TBHV) and 30 lab technicians (LT) preparing over 400 sputum smears a month) answered a questionnaire and were assessed clinically. Pre-employment TB vaccination status and Mantoux test results were recorded and point prevalence of pulmonary TB (June 2005) was estimated. Results One TBHV and 4 LTs were clinicoradiologically diagnosed with pulmonary TB. None of the cases had prior vaccination; all had a positive Mantoux test suggesting intact cell-mediated immunity; all were employed >6 years as a TB HCW; none were known domestic TB contacts. A higher occurrence of TB was found in LTs compared to TBHVs, in keeping with a previous Scottish study (Capewell S, Leaker AR, Leitch AG. Pulmonary tuberculosis in health service staff: is it still a problem? Tubercle 1988; 69:113-8.) but the z - test was not significant at 5% level of significance for the two proportions. Discussion TB HCWs working in countries with high TB prevalence appear to be at a high risk for TB disease. Routine annual chest radiographs have been shown to fail to identify 60% of new cases. We recommend tuberculin skin tests at periodic intervals for high risk HCWs in similar settings (an annual tuberculin skin test conversion rate of 3.96% and a significant linear relationship between acquisition of TB infection and HCW training duration has been previously demonstrated in the same institution in India). Further studies to determine screening frequency are necessary and interferon gamma based assays are likely to have a significant role, particularly in those prior vaccination.

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Comments

Cited paper:
Abstract Available for Pulmonary tuberculosis in health service staff-is it still a problem? Capewell S, Leaker AR, Leitch AG, Pulmonary tuberculosis in health service staff-is it still a problem?, Tubercle, 1988;69:113-118,

4/28/2008

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