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Journal of Public Health Advance Access published online on June 28, 2007
Journal of Public Health, doi:10.1093/pubmed/fdm042
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© The Author 2007, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Survey of tuberculosis incidents in hospital healthcare workers, England and Wales, 2005{dagger}


Charlotte Anderson, Scientist (Epidemiology)1
Ibrahim Abubakar, Consultant Epidemiologist1,
Helen Maguire, Regional Epidemiologist2
Pam Sonnenberg, Senior Lecturer in Epidemiology1,3

1 Respiratory Diseases Department, Centre for Infections, Health Protection Agency, Colindale, NW9 5EQ, UK
2 London Regional Epidemiology, Health Protection Agency, Holborn, London, UK
3 Centre for Sexual Health and HIV Research, University College London, London, UK


Address correspondence to Ibrahim Abubakar, E-mail: ibrahim.abubakar{at}hpa.org.uk


  Abstract

Background Tuberculosis (TB) incidence has increased in England and Wales since 1987, with much of the increase in migrants from high TB incidence countries. The National Health Service increasingly depends on healthcare workers (HCWs) trained abroad, often from areas of high TB incidence. A retrospective survey of TB incidents in hospital-based HCWs was carried out to describe their frequency, distribution and characteristics.

Methods Reports of HCWs with TB in hospitals were identified among routine surveillance of TB incidents. Additional data on these and reports of further incidents fitting the study definition were obtained by contacting local and regional Health Protection Units.

Results At least 105 incidents of TB in hospital-based HCWs occurred in England and Wales in 2005. Most involved HCWs from high incidence countries, and most cases had pre-employment occupational health screening. We found no evidence of onward transmission within hospitals.

Conclusions Pre-employment screening for active disease may not be enough to prevent the occurrence of these incidents. A high index of suspicion among HCWs with TB symptoms is needed. Detection of latent infection with interferon gamma release assays, and the use of preventive treatment, should be evaluated.

Keywords: tuberculosis, healthcare workers, hospitals

{dagger} This survey was carried out with national surveillance data. The Health Protection Agency has Patient Information Advisory Group approval to hold and analyse national surveillance data for public health purposes under Section 60 of the UK Health and Social Care Act 2001. Specific ethical approval was therefore not required.


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