SA health workers face threefold higher TB risk

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That illness is an occupational hazard on the front lines of health care is not new, a Clinical Infectious Diseases supplement on tuberculosis control in health settings notes, but it continues to be neglected at every level. And, as authors of one article note, while the death toll of the 2014-2015 Ebola outbreak is replicated by tuberculosis every three days worldwide, health workers in high burden and low-resource settings face risks at least three times those of the general population. They include doctors, nurses, counsellors, administrative staff, lab technicians and medical students, and in settings across the world they are in short supply.

Yet while responsibility for worker protections and infection control need to be shared by government policy, facility management and supervisory levels as well as individuals, one piece in the supplement notes, too often systemic approaches are neglected by an emphasis on personal protective equipment.

The study found that KwaZulu-Natal health workers face tuberculosis risks up to three times those of general population, while infection control and worker protections lag. HIV infection was found to be the greatest single risk factor for tuberculosis among th respondents.

The results call for improved infection control efforts that include adequate ventilation and stepped up identification, isolation, and care for patients with suspected or confirmed tuberculosis, as well as accelerated efforts to provide HIV testing and treatment to health workers.

The supplement includes case histories: of a South African medical student diagnosed with tuberculosis whose greatest worry was the setback to her studies, until she learned she had multidrug-resistant tuberculosis, which had killed one of her classmates; a physician being treated for multidrug resistant tuberculosis facing the choice of losing her life, or losing her career when she began to lose her hearing, a standard side effect of her treatment; and another physician diagnosed with extensively drug-resistant tuberculosis, a strain of disease resistant to at least two first line treatments and at least three second line treatments.

In fact, the case history piece notes, with authors that include the physician whose hearing was threatened, while health workers face triple the risks of getting sick with tuberculosis than others in their communities, in South Africa they are up to six times more likely to contract disease that is resistant to first line treatments.

Risks increase steeply with HIV infection, another article that explored occupational risk factors for tuberculosis among healthcare workers in KwaZulu-Natal, South Africa shows. The authors of that study, led by Carrie Tudor of Johns Hopkins University School of Nursing, reviewed surveys of 145 workers in high tuberculosis settings and found HIV infection to be the greatest single risk factor for tuberculosis among respondents. The results call for improved infection control efforts that include adequate ventilation and stepped up identification, isolation, and care for patients with suspected or confirmed tuberculosis, as well as accelerated efforts to provide HIV testing and treatment to health workers.

Another pieces the weight of stigma surrounding both HIV and TB among health workers, showing how it hinders access to onsite services. The upshot, authors note, is that a pervasive, supported and committed approach is necessary if the global health threat of tuberculosis is to be ended, with resources that match the dangers the disease poses to those on the front lines.

Abstract: KZN health workers
Background: Tuberculosis is a known occupational hazard for healthcare workers (HCWs), especially in countries with a high burden of tuberculosis. It is estimated that HCWs have a 2- to 3-fold increased risk of developing tuberculosis compared with the general population. The objective of this study was to identify occupational risk factors for tuberculosis among HCWs in 3 district hospitals with specialized multidrug-resistant tuberculosis wards in KwaZulu-Natal, South Africa.
Methods: We conducted a case-control study of HCWs diagnosed with tuberculosis between January 2006 and December 2010. Cases and controls were asked to complete a self-administered questionnaire regarding potential risk factors for tuberculosis.
Results: Of 307 subjects selected, 145 (47%) HCWs responded to the questionnaire; 54 (37%) tuberculosis cases and 91 (63%) controls. Cases occurred more frequently among clinical staff 46% (n = 25) and support staff 35% (n = 19). Thirty-two (26% [32/125]) HCWs were known to be infected with human immunodeficiency virus (HIV), including 45% (21/54) of cases. HCWs living with HIV (odds ratio [OR], 6.35; 95% confidence interval [CI], 3.54–11.37) and those who spent time working in areas with patients (OR, 2.24; 95% CI, 1.40–3.59) had significantly greater odds of developing tuberculosis, controlling for occupation, number of wards worked in, and household crowding.
Conclusions: HIVwas the major independent risk factor for tuberculosis among HCWs in this sample. These findings support the need for HCWs to know their HIV status, and for HIV-infected HCWs to be offered antiretroviral therapy and isoniazid preventive therapy. Infection prevention and control should also be improved to prevent transmission of tuberculosis in healthcare settings to protect both HCWs and patients.

Science Speaks blog
Clincal Infectious Diseases supplement
Case histories
Abstract: KZN health workers


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