Tuberculosis transmission from healthcare workers to patients and co-workers: a systematic literature review and meta-analysis

Monica Sañé Schepisi; Giovanni Sotgiu; Silvia Contini; Vincenzo Puro; Giuseppe Ippolito; Enrico Girardi

doi:10.1371/journal.pone.0121639

Tuberculosis transmission from healthcare workers to patients and co-workers: a systematic literature review and meta-analysis

PLoS One. 2015 Apr 2;10(4):e0121639. doi: 10.1371/journal.pone.0121639. eCollection 2015.

Authors

Monica Sañé Schepisi¹, Giovanni Sotgiu², Silvia Contini¹, Vincenzo Puro¹, Giuseppe Ippolito³, Enrico Girardi¹

Affiliations

¹ Department of Epidemiology and Preclinical Research, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy.
² Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU Sassari, Sassari, Italy.
³ Office of the Scientific Director, L. Spallanzani National Institute for Infectious Diseases, Rome, Italy.

Abstract

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.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adult
Child
Female
Health Personnel / ethics*
Humans
Infant
Infectious Disease Transmission, Professional-to-Patient / prevention & control
Infectious Disease Transmission, Professional-to-Patient / statistics & numerical data*
Male
Mycobacterium tuberculosis / physiology*
Patients
Risk Factors
Tuberculosis, Pulmonary / prevention & control
Tuberculosis, Pulmonary / transmission*

Grants and funding

This work was supported by the Italian Ministry of Health – “Ricerca Finalizzata” Grant no. RF-2009-1499157 and “Ricerca Corrente” INMI Spallanzani. The funder had no role in planning or conducting the review or in the decision to publish its results. Monica Sañé Schepisi is a post-graduate student and the recipient of a scholarship from the Specialisation School of Hygiene and Preventive Medicine, Tor Vergata University, Rome, Italy. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.