The CDC published data1 on the level of tuberculosis in healthcare workers, which was used in part to support the recent recommendations2 to drop routine annual TB testing in the absence of an exposure or ongoing transmission.

The epidemiology has shifted, with workers coming from countries endemic for TB much more likely to manifest later symptoms. Although it must be underscored that there still is TB in the United States, healthcare workers are not at the risk they once were.

“Historically, U.S. healthcare personnel were at increased risk for latent infection and TB disease from occupational exposures,” says study co-author Carla A. Winston, PhD, MA, associate director for science in the CDC’s Division of TB Elimination. “However, recent data show that is no longer the case.”

Risk Factors Are Rare

Among 64,770 adults with TB between 2010 and 2016, 4% were healthcare personnel. The estimated case rate for healthcare personnel was 2.5 TB cases per 100,000 healthcare personnel, which was similar to the average national TB case rate of 3.2 cases per 100,000 persons, she notes.

“Medical and social risk factors for TB among healthcare personnel are rare,” Winston says. “TB risk factors such as diabetes, homelessness, excess alcohol use, or drug use are less common among healthcare personnel compared with other adults.”

Findings also indicate that healthcare personnel are infectious for a shorter time period, as evidenced by sputum conversion; have a lower proportion of cases attributed to recent transmission; and experience better treatment outcomes compared with other adults, she says.

“National surveillance data from 1995-2007 estimated the rate of TB among non-U.S.-born healthcare personnel [HCP] in the United States to be 10 times higher than among U.S.-born HCP,” Winston and colleagues reported. “Recent TB transmission has been estimated to account for [approximately] 15% of TB cases diagnosed in the United States, but it has not been examined for HCP versus other adults.”

Efforts to Curb TB in Healthcare Workers

TB reduction in healthcare was not a coincidence. It resulted after concerted TB control efforts followed outbreaks in healthcare facilities in the 1990s. The CDC recommends policies and procedures for TB control should be reviewed periodically and evaluated for effectiveness. While annual routine screening is no longer recommended, employee health professionals should base their policies on their local situation and TB prevalence in the community.

“Healthcare facilities might consider using serial TB screening for certain groups at increased occupational risk for TB exposure; for example, pulmonologists or respiratory therapists,” Winston says. “Or, in certain settings where transmission has occurred in the past, like emergency departments.”

It also is important that all healthcare workers receive annual TB education, she says. TB education should include information on risk factors, signs and symptoms, and TB infection control policies and procedures, the CDC recommends. Treatment for TB is strongly encouraged for healthcare personnel diagnosed with develop latent TB infection, Winston says.

REFERENCES

  1. Mongkolrattanothai T, Lambert LA, Winston CA. Tuberculosis among healthcare personnel, United States, 2010-2016. Infect Control Hosp Epidemiol 2019;40:701-704.
  2. Sosa LE, Njie GJ, Lobato MN, et al. Tuberculosis screening, testing, and treatment of U.S. health care personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. MMWR Morb Mortal Wkly Rep 2019;68:439-443.