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

ECG registered on May 22, 2015.

<p>ECG registered on May 22, 2015.</p

ECG registered on May 15, 2015.

<p>ECG registered on May 15, 2015.</p

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

Predictors associated with completion of PEP among the total number of people with suspected rabid animal bites from 2008 to 2014 in Dodoma Region (10,771).

<p>Predictors associated with completion of PEP among the total number of people with suspected rabid animal bites from 2008 to 2014 in Dodoma Region (10,771).</p

Total number of suspected rabid animal bites in Dodoma region.

<p>(a) Total number of suspected rabid animal bites from 2008 to 2014 distributed per district. (b) Diagram of number of suspected rabid animal bites per district and year.</p

Characteristics of reported suspected rabid animal bites and post-exposure prophylaxis.

<p>(a) Proportion of suspected rabid animal bites over total number of bites per year. (b) Animal species responsible for bites. (c) Post-exposure prophylaxis administered between 2008 and 2014.</p

Predictors associated with delay to health care access among people with suspected rabid animal bites in Dodoma, Tanzania (10,771).

<p>Predictors associated with delay to health care access among people with suspected rabid animal bites in Dodoma, Tanzania (10,771).</p

Patients’ characteristics, delay, PEP administration and follow up of suspected rabid animal bites.

<p>Patients’ characteristics, delay, PEP administration and follow up of suspected rabid animal bites.</p