Risk of prevalence of latent tuberculosis infection in health care workers-an idiographic meta-analysis from a Chinese perspective

Hai-Yan Guo; Qian-Hong Zhong; Jie Zhou; Zhi-Meng Zhao; Xi-Lin Zhang; Zhen-Huang Chen; Xin-Cai Qiu; Zhi-Long Wu

doi:10.21037/jtd-20-1612

Risk of prevalence of latent tuberculosis infection in health care workers-an idiographic meta-analysis from a Chinese perspective

J Thorac Dis. 2021 Apr;13(4):2378-2392. doi: 10.21037/jtd-20-1612.

Authors

Hai-Yan Guo¹, Qian-Hong Zhong², Jie Zhou³, Zhi-Meng Zhao², Xi-Lin Zhang², Zhen-Huang Chen^{1

4}, Xin-Cai Qiu^{1

4}, Zhi-Long Wu²

Affiliations

¹ Department of Respiratory Medicine, Nanhai Hospital Affiliated to Southern Medical University, Foshan, China.
² Department of Respiratory Medicine, The Fourth People's Hospital of Foshan (Tuberculosis Control Center of Foshan), Foshan, China.
³ Department of Respiratory Medicine, Foshan Hospital of TCM, Foshan, China.
⁴ The Second School of Clinical Medicine, Southern Medical University, Foshan, China.

Abstract

Background: China is one of the countries sharing the major burden of tuberculosis (TB) in the world. Health care workers (HCWs) are subject to a high risk of occupational latent tuberculosis infection (LTBI)-an asymptomatic state of TB disease. However, the heterogenic composition of healthcare professionals in terms of nature of their work leads to the inconsistency in predicting the prevalence of LTBI amongst them. Furthermore, the global statistics do not account for the analysis conducted within the Chinese population. Our study reflects a systemic and epidemiological meta-analysis to investigate the risk of contracting LTBI by the HCWs of China.

Methods: A systematic review of the literature was performed to identify studies reporting LTBI prevalence or incidence among HCWs and a control groups in China. Risk of infection, as well as subgroup analysis was calculated by pooled effect estimates. Review Manager 5.0 was used to perform the meta-analyses.

Results: Twenty studies containing 9,654 HCWs met the inclusion criteria. The average prevalence of LTBI among HCWs was 51.5%, ranging from 27.9-88.8%. HCWs had a higher risk of prevalence of LTBI than the control groups [odds ratio (OR), 1.78, 95% confidence interval (CI), 1.46-2.16]. In the subgroup analysis, the prevalence of LTBI in HCWs with respect to the control groups was observed to be highest in Eastern China (OR, 2.05; 95% CI, 1.35-3.11). Furthermore, the pooled OR for LTBI was 1.90 and 1.65 separately from the results of the tuberculin skin test (TST) and the interferon-gamma release assay. Lastly, upon comparing the HCWs with the control groups from the community and the nosocomial source, it was observed that the pooled OR favored for the prevalence of LTBI, which was primarily community-sourced (3.12 and 1.54). HCWs had an increased risk of prevalence of LTBI than the control groups, both in general hospitals and TB specific hospitals (pooled OR 2.4 and 1.57).

Conclusions: Risk of LTBI infection among HCWs is relatively high in China, especially in the eastern region, predisposed by the cumulative exposure to Mycobacterium tuberculosis from the community and the general hospitals. Overall, our data reflects an alarming risk posed to our HCWs, and calls for immediate reforms at the policy levels, so as to implement effective screening and treatment of affected HCWs in China.

Keywords: China; Latent tuberculosis infection (LTBI); health care workers (HCWs); occupational diseases; prevalence.