Hong Kong Med J 2006;12:448-55 | Number 6, December 2006
Occupational tuberculosis: a review of the literature and the local situation
CM Tam, CC Leung
Tuberculosis and Chest Service, Public, Health Services Branch, Centre for Health Protection, Department of Health, Government of Hong Kong SAR
OBJECTIVE. To review the risks and control of occupation-related tuberculosis.
DATA SOURCES. Statutory notification data, local tuberculosis programme data, and census data were reviewed. Literature search of PubMed was performed up to December 2005.
STUDY SELECTION. Original and major review articles related to tuberculosis among health care workers and guidelines for prevention were reviewed.
DATA EXTRACTION. Relevant data were extracted from our literature review and local sources.
DATA SYNTHESIS. Earlier experimental data demonstrated an airborne spread of tuberculosis and a steady state mathematical model for quantification of the transmission risk. In the post-chemotherapy era in developed countries, few studies demonstrated an occupational risk of tuberculin conversion outside of outbreak settings, and few studies were able to conclusively demonstrate an increased risk of active tuberculosis among health care workers. In countries with limited resource, the situation may be different, with a higher tuberculosis incidence among health care workers. Local tuberculosis programme and notification data from the Labour Department did not show an increased risk of active tuberculosis among health care workers. Although administrative control, engineering control, and personal protection are widely accepted control measures, it is difficult to quantify their cost-effectiveness.
CONCLUSIONS. Although an increased liability to tuberculosis among health care workers is expected due to the concentration of infectious patients in their environment, prompt diagnosis and initiation of treatment may minimise the risk. A high background rate of disease and possible healthy worker effect may make it difficult to pick up a small risk differential. With the ongoing threat of a nosocomial outbreak, continuing vigilance is called for.
Key words: Health personnel; Hong Kong; Occupational diseases; Tuberculosis
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