>> /Type /Page Author contributions: R. Diel conceived and designed the study, acquired, analysed and interpreted the data, and drafted and revised the article. Jahresbericht [Notifiable Infectious Diseases in Hamburg 2001. Examples of clusters “imported” to Hamburg. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. We thank all authors who provided additional information or clarification: Dr Ashantha Naidoo, Dr Cyril Naidoo, Dr Karen Lockhart, Dr Annalee Yassi and Dr Sally Millership. 2011-02-23T12:22:28-05:00 Moreover, all included studies considered TST or IGRA positivity in children at the first screening as evidence of LTBI acquired following exposure to the index case. /F5 25 0 R The Prevalence and Demographic Risk Factors for Latent Tuberculosis Infection (LTBI) Among Healthcare Workers in Semarang, Indonesia. Of particular importance for the targeting of the TB control by public health authorities is the analysis of those cases that are due to “recent transmission”. The review protocol is available on request from the authors. In cluster A, which consists of two Turkish citizens, the first patient migrated to Hamburg in July 1997 and presented a cervical lymph node TB caused by reactivation of a formerly latent M. tuberculosis infection. To assess the annual risk for latent tuberculosis infection (LTBI) among health care workers (HCWs), the incidence rate ratio for tuberculosis (TB) among HCWs worldwide, and the population-attributable fraction of TB to exposure of HCWs in their work settings, we reviewed the literature. Transmission rates above 20% have been estimated among adults in other congregate settings based on LTBI prevalence [21]. DNA fingerprinting denotes molecular typing of a strain of M. tuberculosis complex, and ideally addresses the question of whether a single endogenous reactivation of an earlier latent TB infection has developed in a TB patient or whether a “fresh” transfer by an index person has occurred. Combined proportions of active TB cases among exposed individuals were: 0.11% (95% CI 0.04–0.21) for infants (Fig 2A), 0.38% (95% CI 0.01–1.60) for children (Fig 2B), 0.09% (95% CI 0.02–0.22) for adults (Fig 2C) and 0.00% (95% CI C.I 0.00–0.38) for HCWs (Fig 2D). In 2015 the TB incidence of 10.8 per 100 000 in Hamburg was above the national average of 7.3 per 100 000 inhabitants [2]. Higher infection transmission rates in HCA settings have also been reported by a systematic review [63] on exposed infants when the index was the mother (1.49%), while lower rates were found when the index case was an infant (0.00%). There he suffered progression to TB disease after <8 months. In cumulative studies on exposed infants or children (S1 Table: Table C), infected cases were 2/201 (0.01%) and 10/1,613 (0.62%), respectively.
Thus, M. tuberculosis transmission between the two patients could be excluded a priori. 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. This site needs JavaScript to work properly. Enter multiple addresses on separate lines or separate them with commas. Conceived and designed the experiments: GS.
/Subtype /Link stream /Subtype /Link Furthermore, the number of unidentified, recently transmitted and occupationally acquired cases may be high, as only those healthcare workers were investigated who were residents of Hamburg proper. PLoS One. The patient returned to Romania after 6 months' treatment in 2008. No, Is the Subject Area "Dentition" applicable to this article? Among the 224 clusters, 97 (43.3%) were found in which at least one transmission from cluster member to another was epidemiologically confirmed. /Font Effectiveness of alternative strategies, such as initial restriction of screening to those most intensively exposed, extended to those at a lower risk (if transmission is found in the highest-risk group [41]) should be evaluated. 9 0 obj << Two male prostitutes (strain no. Int J Tuberc Lung Dis. /Dest (�� b m k _ C 5) Categorical data were compared using Pearson's Chi-squared test (or Fisher's exact test, when the expected cell sizes were smaller than five). 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 … uuid:2be391e9-03c5-424e-9b43-a57ea5e5df51 Thus, our longitudinal study underlines again that the transmission of TB in healthcare facilities may be of great significance. No, PLOS is a nonprofit 501(c)(3) corporation, #C2354500, based in San Francisco, California, US, https://doi.org/10.1371/journal.pone.0121639, http://www.outbreak-database.com/Home.aspx, http://whqlibdoc.who.int/publications/2009/9789241598323_eng.pdf, http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp, http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Tuberculosis/TBUKSurveillanceData/TBIncidentAndOutbreakSurveillance/. /Rect [390.274 450.255 394.583 459.269] In total, two healthcare workers had MDR-TB. If the respective index persons were included, 340 patients (37.0% of all cluster members) were from a confirmed epidemiological context. Our work began with the performance of univariate analysis to identify significant differences between the 918 clustered patients and the 1475 non-clustered patients (table 1). Healthcare workers were significantly more frequently cluster members (29 (3.2%) out of 918 versus 26 (1.8%) out of 1475, p<0.05).
6 0 obj Although the majority of TB diseases in healthcare workers in our Hamburg study resulted from reactivation of latent TB infection with an unclear origin, more than a quarter (15 out of 51 healthcare workers, 27.3%) could be shown to have acquired the underlying infections within the healthcare system. For more information about PLOS Subject Areas, click >> The differentiation between the species of the M. tuberculosis complex was based on genotyping data of each individual isolate [7–9]. Skodric V, Savic B, Jovanovic M, Pesic I, Videnovic J, Zugic V, Rakovic J, Stojkovic M. Int J Tuberc Lung Dis. Bevölkerung in Hamburg 2015. These outbreaks were attributed to delayed diagnosis of infectious TB patients, unrecognized drug resistance and inadequate infection control measures. At that time, transmission was found to be strongly associated with work in the healthcare professions. However, to provide a firm evidence base for the screening strategies, more and better information is needed. We systematically reviewed the medical literature to evaluate the current evidence on the risk of HCA-TB transmission from HCWs. 5 0 obj << In cluster E, the first patient, whose pulmonary TB had already been diagnosed in Romania, was treated immediately after arrival in Hamburg without making contact with any compatriots. RF-2009-1499157 and “Ricerca Corrente” INMI Spallanzani. a) IS6110 restriction fragment length polymorphism (RFLP) and b) spoligotyping patterns of a multidrug-resistant tuberculosis (MDR-TB) cluster. Tuberculosis transmission among healthcare workers http://ow.ly/aGn030iGLvF. The combined proportion of infants with TB infection was 0.28% (95% CI 0.07–0.65) if the only study (29) in which IGRAs were used to detect LTBI is excluded. 2016 Oct 12;11:Doc22. In the meantime, Kamper-Jørgensen et al. As conventional contact tracing plays only a minor role in the detection of TB transmission, continuous insight into the effectiveness of control measures in healthcare facilities can only be provided by genotyping of M. tuberculosis strains. << >> /Rect [415.559 368.22 419.868 377.235] A literature review [47] on school outbreaks involving children aged three to 11 as close contacts reported weighted average TB transmission rates of 39.3% and 69.8% if the index case was an adult or a child, respectively. Identical IS6110 RFLP and spoligotyping patterns of the isolates of 11 MDR-TB cluster members.
Therefore, these were excluded from further analysis.
984 (41.4%) patients were born in Germany. Characteristics of the 117 index cases are summarised in Table 1. https://doi.org/10.1371/journal.pone.0121639.t001. CDC Updates TB Recommendations for Health Care Workers. Contributed to the interpretation of results and to the discussion and revision of the manuscript: VP GI. /Border [0 0 0] Yes The limited information retrieved however, suggests that this compliance may be suboptimal. Repeated TST administration to identify the booster phenomenon was used in one study only [33].
2018 Aug 31;84(3):342-347. doi: 10.29024/aogh.2304. On average, each of the 1864 patient with culture-confirmed and thus potentially infectious pulmonary TB had 5.8±8.7 contact individuals (median 4, range 0–77).
Analyzed the data: GS. Table 3 shows five examples of clusters of foreign-born residents of Hamburg from different years, where it was obvious at the outset that transmission could not have occurred recently; the clear assumption is that the cluster members had been infected by a highly prevalent regional strain in their respective home country before “importing” it to Hamburg.
Tuberculin skin testing to assess the occupational risk of Mycobacterium tuberculosis infection among health care workers in Abidjan, Côte d'Ivoire. No, Is the Subject Area "Tuberculosis diagnosis and management" applicable to this article? The results of the population-based Hamburg fingerprint study deliver a detailed picture of TB epidemiology over a period of 19 years and demonstrate that, even in a country with a low TB incidence, a large proportion of the TB disease may be due to recent transmission. /Subtype /Link
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