High risk for latent tuberculosis infection among medical residents and nursing students in India

PLoS One. 2019 Jul 8;14(7):e0219131. doi: 10.1371/journal.pone.0219131. eCollection 2019.

Abstract

Defining occupational latent tuberculosis infection (LTBI) risk among healthcare workers is needed to support implementation of prevention guidelines. Prospective cohort study of 200 medical residents and nursing students in India was conducted May 2016-December 2017. Tuberculin skin test (TST) and QuantiFERON TB Gold Test-in-tube (QFT-GIT) were performed at study entry and 12 months. Primary outcome was incident LTBI (≥10mm TST induration and/or ≥0.35IU/mL QFT-GIT) at 12 months; secondary outcomes included baseline LTBI prevalence and risk factors for incident and prevalent LTBI using Poisson regression. Among 200, [90 nursing students and 110 medical residents], LTBI prevalence was 30% (95% CI, 24-37); LTBI incidence was 26.8 (95% CI, 18.6-37.2) cases per 100 person-years and differed by testing method (28.7 [95% CI, 20.6-38.9] vs 17.4 [95% CI, 11.5-25.4] cases per 100 person-years using TST and QFT-GIT, respectively). Medical residents had two-fold greater risk of incident LTBI than nursing students (Relative Risk, 2.16; 95% CI, 1.05-4.42). During study period 6 (3%) HCWs were diagnosed with active TB disease. Overall, median number of self-reported TB exposures was 5 (Interquartile Range, 1-15). Of 60 participants with prevalent and incident LTBI who were offered free isoniazid preventive therapy (IPT), only 2 participants initiated and completed IPT. High risk for LTBI was noted among medical residents compared to nursing students. Self-reported TB exposure is underreported, and uptake of LTBI prevention therapy remains low. New approaches are needed to identify HCWs at highest risk for LTBI.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antitubercular Agents / therapeutic use
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • India / epidemiology
  • Interferon-gamma Release Tests
  • Internship and Residency*
  • Isoniazid / therapeutic use
  • Latent Tuberculosis / drug therapy
  • Latent Tuberculosis / epidemiology*
  • Latent Tuberculosis / prevention & control
  • Longitudinal Studies
  • Male
  • Occupational Diseases / drug therapy
  • Occupational Diseases / epidemiology*
  • Occupational Diseases / prevention & control
  • Occupational Exposure / prevention & control
  • Prevalence
  • Prospective Studies
  • Risk Factors
  • Students, Nursing*
  • Tuberculin Test
  • Young Adult

Substances

  • Antitubercular Agents
  • Isoniazid