Tuberculosis in Healthcare Workers

This study investigates the factors affecting the implementation of active tuberculosis (TB) surveillance in rural and urban districts of the Eastern Cape, South Africa, from the perspective of healthcare workers. Utilizing a cross-sectional survey method, data was gathered via an electronic questionnaire through REDCap software. The approach effectively captures healthcare workers' views on systemic and contextual challenges at a specific time, though self-reported data may introduce bias, and the focus solely on healthcare workers might overlook patient and community stakeholder insights.[1]

Variables in this study include independent variables such as geographical settings (rural vs. urban districts) and healthcare worker demographics and roles. Dependent variables involve factors impacting TB surveillance like training, transportation, coordination, and community acceptance. Confounding factors include socioeconomic disparities and variations in clinic resources, while control variables were demographic comparatives of the survey participants. Key results indicated significant challenges like CHW transport issues and community distrust, alongside a substantial discrepancy in resource allocation between rural and urban settings. The study concludes that multiple barriers, including leadership and resource deficiencies, affect TB surveillance, necessitating tailored interventions for different locales.[1]

In Taiwan, Tuberculosis (TB) poses a significant occupational risk for healthcare workers (HCWs), who exhibit a higher incidence of active TB compared to the general population when adjusted for age, sex, and diagnosis year. Notably, the outcomes of TB in HCWs are more favorable than those of non-HCW patients treated in the same settings, primarily due to factors such as the healthy worker effect, expedited diagnosis, and reduced treatment delays, all contributing to lower TB mortality rates among healthcare workers.[2]

A nested randomized controlled trial, part of the BRACE phase 3 study, assessed the effect of BCG-Denmark revaccination on preventing Mycobacterium tuberculosis infection among adult healthcare workers in Brazil—a country with high TB burden. A total of 1,985 participants with valid baseline QFT Plus results were enrolled across three sites (Campo Grande, Manaus, and Rio de Janeiro), with 996 receiving BCG and 989 receiving placebo. Initial QFT Plus conversion rates were similar between groups (BCG: 3.4%; placebo: 3.2%; RR 1.09, 95% CI 0.67–1.77; p = 0.791), and sustained conversion rates showed no significant difference either (BCG: 1.5%; placebo: 1.9%; RR 0.80, 95% CI 0.41–1.57; p = 0.510).[3]

Alternative thresholds for QFT positivity (0.7 IU/mL and 2.0 IU/mL) and subgroup analysis of participants with low baseline IFN-γ levels (0.2 IU/mL) also revealed no meaningful difference between BCG and placebo arms. These findings suggest that BCG-Denmark revaccination does not significantly reduce the risk of initial or sustained QFT Plus conversion in previously uninfected adult healthcare workers, indicating limited benefit for TB infection prevention in this population.[3]

References:

1. Ajudua, F.I. and Mash, R.J., 2024. Implementing active surveillance for TB: A descriptive survey of healthcare workers in the Eastern Cape, South Africa. African Journal of Primary Health Care & Family Medicine, 16(1), p.4217.

2. Pan S-C, Chen Y-C, Wang J-Y, Sheng W-H, Lin H-H, Fang C-T, et al. (2015) Tuberculosis in Healthcare Workers: A Matched Cohort Study in Taiwan. PLoS ONE 10(12): e0145047.

3. Dos Santos, P.C.P., Messina, N.L., de Oliveira, R.D., da Silva, P.V., Puga, M.A.M., Dalcolmo, M., Dos Santos, G., de Lacerda, M.V.G., Jardim, B.A., e Val, F.F.D.A. and Curtis, N., 2024. Effect of BCG vaccination against Mycobacterium tuberculosis infection in adult Brazilian health-care workers: a nested clinical trial. The Lancet Infectious Diseases, 24(6), pp.594-601.