Tuberculosis among Healthcare Workers, United States, 2010-2016 Open Access

Mongkolrattanothai, Thitipong (Spring 2018)

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Background: Occupational risk of tuberculosis (TB) remains a public health concern for healthcare workers (HCWs). We compare the characteristics between HCWs and other adults in the United States, and describe the measure of association between HCWs and exclusively pulmonary TB (PTB) as well as sputum culture conversion, by examining U.S. national TB surveillance data from 2010 to 2016.

Methods: TB cases reported from 50 states and the District of Columbia from 2010 through 2016 were analyzed. Demographic, clinical, and risk factors were compared between HCWs with TB and other adults with TB. Multivariable logistic regression models were used to assess the relationship between the main exposure variable, HCW/other adult, and main outcome variables, disease site and sputum conversion.

Results: Among 64,770 total TB cases involving patients 18 years of age or older reported from 2010 through 2016 to the National Tuberculosis Surveillance System, 2,460 (4%) were classified as HCWs, and 62,310 (96%) were classified as other adults. HCWs were less likely to have exclusively PTB (uOR, 0.70 [95% CI, 0.64-0.76]). Analyses of HCWs were also stratified by origin of birth. Among U.S.-born persons with TB, there was no significant difference between HCWs and other adults for PTB (uOR, 0.89 [95% CI, 0.74-1.07]; aOR, 1.09 [95% CI, 0.90-1.31]). Among non-U.S.-born persons, unadjusted and adjusted estimates show that HCWs were less likely than other adults to have exclusively PTB (uOR, 0.67 [95% CI, 0.61-0.74]; aOR, 0.76 [95% CI, 0.69-0.84]). HCWs were more likely to have a sputum culture conversion of < 60 days compared with other adults (uOR, 1.49 [95% CI, 1.26-1.77]; aOR, 1.24 [95% CI, 1.04-1.48]).

Conclusion: Although there may be occupational risks in healthcare settings, this study demonstrates that being a HCW was negatively associated with PTB. HCWs are more likely to convert their sputum culture to negative within 60 days compared with other adults. Other variables such as birth country status may be a more important risk factor for TB, even among HCWs.

Table of Contents

Background                                                                                                                   1

Methods                                                                                                                        6

Results                                                                                                                        13

Discussion                                                                                                                  17

References                                                                                                                  22

Tables and Figures                                                                                                      28

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