Tuberculosis Transmission from Healthcare Workers to Patients and Co-workers: A Systematic Literature Review and Meta-Analysis

<div><p>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.</p></div

Characteristics of 117 Health Care Workers index cases of pulmonary Tuberculosis in 34 included studies.

<p>Characteristics of 117 Health Care Workers index cases of pulmonary Tuberculosis in 34 included studies.</p

Proportion meta-analysis (random effects).

<p>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).</p

Response to selected RD1 peptides in Ugandan HIV-infected patients with smear positive pulmonary tuberculosis: a pilot study-1

Ming cells (SFCs) per million PBMC for each individual at the time of diagnosis and 6 months after therapy are reported. For 9/12 individuals data are reported also after 3 months of therapy. The p value denotes the difference between the responders in each group.<p><b>Copyright information:</b></p><p>Taken from "Response to selected RD1 peptides in Ugandan HIV-infected patients with smear positive pulmonary tuberculosis: a pilot study"</p><p>http://www.biomedcentral.com/1471-2334/8/11</p><p>BMC Infectious Diseases 2008;8():11-11.</p><p>Published online 28 Jan 2008</p><p>PMCID:PMC2267196.</p><p></p

Response to selected RD1 peptides in Ugandan HIV-infected patients with smear positive pulmonary tuberculosis: a pilot study-0

Cate individuals with tuberculosis (TB patients) and unshaded symbols indicate individuals without tuberculosis (No active TB). Horizontal lines indicate median values. The TB patient group had a significantly higher response to the sum of ESAT-6 and CFP-10 peptides compared with the group without active TB (p = 0.02).<p><b>Copyright information:</b></p><p>Taken from "Response to selected RD1 peptides in Ugandan HIV-infected patients with smear positive pulmonary tuberculosis: a pilot study"</p><p>http://www.biomedcentral.com/1471-2334/8/11</p><p>BMC Infectious Diseases 2008;8():11-11.</p><p>Published online 28 Jan 2008</p><p>PMCID:PMC2267196.</p><p></p

Additional file 1 of A machine learning approach for early identification of patients with severe imported malaria

Additional file 1: Fig. S1. A visualization of the clusters related to the severe malaria patients, obtained using K-means

Layout of TB laboratory.

<p>Layout of TB laboratory.</p

Map illustrating the sites of the TB laboratories.

<p>A: Central TB Reference Laboratory; B: Pemba Reference Laboratory.</p

Results of influenza A/H1N1pdm serology in 211 crew members of the Italian military ship Scirocco.

<p>Results of influenza A/H1N1pdm serology in 211 crew members of the Italian military ship Scirocco.</p

Distribution of acute respiratory illness (ARI) and suspected A/H1N1pdm cases, according to the time of symptoms onset and to the results of Influenza A/H1N1pdm-specific serological tests.

<p><u>Black bars</u>: seropositives; <u>gray bars</u>: seronegatives.</p