Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries—A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Methods
- (1)
- How high is the prevalence of LTBI among healthcare workers in low-incidence countries, measured using IGRAs?
- (2)
- In which occupational groups or areas of work within the healthcare sectors is there an elevated risk of occupational LTBI?
2.1. Selection Criteria
2.2. Sources of Information and Search Strategy
2.3. Data Management, Study Selection and Data Extraction
2.4. Study Quality
- 1st item: Criteria for inclusion in the sample clearly defined
- 2nd item: Study subjects and setting described in detail
- 3rd item: Exposure measured in a valid and reliable way
- 4th item: Sample size adequate (min. N = 139)
- 5th item: Confounding factors identified/considered
- 6th item: Strategies for dealing with confounding factors indicated
- 7th item: Outcomes measured in a valid and reliable way
- 8th item: Appropriate statistical analysis applied
2.5. Statistical Analysis
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Meta-Analysis—Prevalence of LTBI
3.4. Meta-Analysis—Occupational Risk for LTBI
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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1st Author, yr | Country | Study Design | Study Period | Setting | IGRA Used | No. of HCWs | No. of LTBI | Prevalence (%) | 95% CI | Quality |
---|---|---|---|---|---|---|---|---|---|---|
Europe | ||||||||||
Fox 2009 [19] | Israel | cross-sectional | 2007 | outpatient TB center | QFT-GIT | 100 | 17 | 17.0 | 10.8–25.7 | ++ |
Soborg 2007 [20] | Denmark | cross-sectional | 2007 | infectious disease ward | QFT-GIT | 139 | 2 | 1.4 | 0.7–5.4 | +++ |
Gran 2013 [21] | Norway | cross-sectional | 2008–09 | hospital/TB ward | QFT-GIT | 387 | 18 | 4.7 | 2.9–7.3 | +++ |
Ciaschetti 2007 [22] | Italy | cross-sectional | 2006–07 | hospital | QFT-GIT | 590 | 63 | 10.7 | 8.4–13.4 | +++ |
Girardi 2009 [23] | Italy | cross-sectional | 2004–05 | hospital/TB ward | QFT-GIT T-SPOT.TB ELISPOT | 115 115 115 | 29 42 40 | 25.2 36.5 34.8 | 18.1–33.9 28.3–45.6 26.7–43.9 | +++ |
Larcher 2012 [24] | Italy | cross-sectional | 2006–07 | hospital | QFT-GIT | 621 | 115 | 18.5 | 15.7–21.8 | +++ |
Sauzullo 2014 [25] | Italy | cross-sectional | n/a | hospital | QFT-GIT | 196 | 34 | 17.3 | 12.7–23.3 | ++ |
Magrini 2016 [26] | Italy | cross-sectional | 2007–13 | hospital | QFT-GIT | 939 | 46 | 4.9 | 3.7–6.5 | n.a. |
Stebler 2008 [27] | Switzerland | retrospective | 2005–06 | hospital | QFT-GIT | 777 | 59 | 7.6 | 5.9–9.7 | +++ |
Tripodi 2009 [28] | France | cross-sectional | 2006–07 | hospital | QFT-GIT | 148 | 28 | 18.9 | 13.4–26.0 | +++ |
Faibis 2011 [29] | France | cross-sectional | 2008 | hospital | QFT-GIT | 137 | 16 | 11.7 | 7.2–18.2 | + |
Moucaut 2013 [30] | France | cross-sectional | 2007–11 | hospital | QFT-GIT | 634 | 141 | 22.2 | 19.2–25.6 | +++ |
Nienhaus 2014 [31] | France | prospective | 2008–13 | hospital | QFT-GIT | 1192 | 265 | 22.2 | 20.0–24.7 | +++ |
Lucet 2015 [32] | France | prospective | 2009–10 | hospital | QFT-GIT | 807 | 113 | 14.0 | 11.8–16.6 | ++ |
Barsegian 2008 [33] | Germany | cross-sectional | 2006 | radiology department | T-SPOT.TB | 95 | 1 | 1.1 | <0.01–6.3 | + |
Schablon 2009 [34] | Germany | cross-sectional | 2005–08 | TB hospital | QFT-GIT | 265 | 19 | 7.2 | 4.6–11.0 | +++ |
Schablon 2011 [35] | Germany | prospective | 2008–11 | nursing school | QFT-GIT | 194 | 4 | 2.1 | 0.6–5.4 | ++ |
Schablon 2014 [36] | Germany | prospective | 2006–13 | hospital + nursing home | QFT-GIT | 3823 | 318 | 8.3 | 7.5–9.2 | +++ |
Herzmann 2017 [37] | Germany | prospective | 2008–14 | respiratory hospital | QFT-GIT/ T-SPOT.TB | 280 | 109 | 38.9 | 33.4–44.8 | ++ |
Khanna 2009 [38] | United Kingdom | cross-sectional | n/a | hospital | QFT-GIT | 171 | 13 | 7.6 | 4.4–12.7 | ++ |
Alvarez-Leon 2009 [39] | Spain | cross-sectional | 2007 | hospital | QFT-GIT | 134 | 8 | 5.97 | 2.9–11.5 | +++ |
Casas 2009 [40] | Spain | cross-sectional | 2004–05 | hospital | QFT-GIT T-SPOT.TB | 147 147 | 43 57 | 29.3 38.8 | 22.5–37.1 31.3–46.9 | +++ |
Martinez-Lacasa 2015 [41] | Spain | cross-sectional | 2010–11 | hospital | QFT-GIT | 226 | 17 | 7.5 | 4.7–11.8 | ++ |
Topic 2009 [42] | Croatia | cross-sectional | 2007 | hospital | QFT-GIT | 54 | 17 | 31.5 | 20.6–44.8 | + |
Targowski 2014 [43] | Poland | cross-sectional | n/a | hospital | QFT-GIT | 305 | 27 | 8.9 | 6.1–12.6 | +++ |
Ozdemir 2007 [44] | Turkey | cross-sectional | 2005 | hospital | QFT-GIT | 76 | 65 | 85.5 | 78.7–71.9 | ++ |
Caglayan 2011 [45] | Turkey | cross-sectional | 2005 | TB hospital | QFT-GIT | 78 | 34 | 43.6 | 33.1–54.6 | + |
Babayigit 2014 [46] | Turkey | cross-sectional | n/a | hospital | QFT-GIT | 96 | 19 | 19.8 | 13.0–28.9 | +++ |
Bozkanat 2016 [47] | Turkey | cross-sectional | 2008 | TB hospital | QFT-GIT | 34 | 7 | 20.6 | 10.1–37.1 | + |
Kargi 2017 [48] | Turkey | cross-sectional | n/a | hospital | QFT-GIT | 100 | 23 | 23.0 | 15.8–32.2 | +++ |
Torres Costa 2011 [49] | Portugal | prospective | 2007–10 | hospital | QFT-GIT | 2884 | 953 | 33.0 | 31.4–34.8 | +++ |
Nikolova 2013 [50] | Bulgaria | cross-sectional | 2009 | TB hospital | QFT-GIT | 21 | 10 | 47.6 | 28.3–72.7 | + |
The Americas | ||||||||||
Joshi 2012 [51] | USA | retrospective | 2008–09 | hospital | QFT-GIT | 3290 | 129 | 3.9 | 3.3–4.6 | + |
Dorman 2014 [52] | USA | cross-sectional | 2008–11 | hospital | QFT-GIT T-SPOT.TB | 2418 2418 | 118 144 | 4.9 6.0 | 4.1–5.8 5.1–7-0 | ++ |
Zwerling 2012 [53] | Canada | cross-sectional | 2007–11 | hospital | QFT-GIT | 388 | 24 | 6.2 | 4.2–9.1 | +++ |
Hernandez 2014 [54] | Chile | cross-sectional | 2010–11 | hospital | QFT-GIT | 76 | 20 | 26.3 | 17.7–37.2 | + |
Ochoa 2017 [55] | Colombia | cross-sectional | 2013–15 | hospital | QFT-GIT | 988 | 466 | 47.2 | 44.1–50.3 | ++ |
Western Pacific | ||||||||||
Vinton 2009 [56] | Australia | cross-sectional | n/a | hospital | QFT-GIT | 481 | 32 | 6.7 | 4.7–9.3 | +++ |
Freeman 2012 [57] | New Zealand | cross-sectional | 2007–08 | hospital | QFT-GIT | 325 | 28 | 8.6 | 6.0–12.2 | +++ |
Harada 2006 [58] | Japan | cross-sectional | 2003 | hospital | QFT-GIT | 332 | 33 | 9.9 | 7.7–13.7 | +++ |
Hotta 2007 [59] | Japan | cross-sectional | 2006 | hospital | QFT-2G | 207 | 3 | 1.4 | 0.3–4.4 | ++ |
Adachi 2013 [60] | Japan | cross-sectional | 2011–12 | hospital | QFT-GIT | 165 | 18 | 10.9 | 6.9–16.7 | +++ |
Ogiwara 2013 [61] | Japan | retrospective | 2010–11 | hospital | QFT-GIT | 585 | 5 | 0.9 | 0.3–2.1 | ++ |
Uto 2014 [62] | Japan | prospective | 2007–10 | hospital | QFT-2G | 951 | 28 | 2.9 | 2.0–4.2 | +++ |
Mukai 2017 [63] | Japan | cross-sectional | 2008–11 2011–14 | hospital | QFT-GIT T-SPOT.TB | 140 140 | 6 8 | 4.3 5.7 | 1.8–9.2 2.8–11.0 | +++ |
Tanabe 2017 [64] | Japan | cross-sectional | 2015 | hospital | QFT-GIT T-SPOT.TB | 654 | 19 28 | 2.9 4.3 | 1.8–4.5 3.0–6.1 | +++ |
Eastern Mediterranean | ||||||||||
El-Helaly 2014 [65] | Saudi Arabia | cross-sectional | 2009–11 | hospital | QFT-GIT | 1412 | 333 | 23.6 | 21.4–25.9 | +++ |
Hassan 2014 [66] | Saudi Arabia | cross-sectional | 2012 | laboratory | QFT-GIT | 134 | 26 | 19.4 | 13.6–27,0 | +++ |
Al Hajoj 2016 [67] | Saudi Arabia | cross-sectional | 2012–15 | hospital | QFT-GIT | 1595 | 399 | 25.0 | 23.0–27.2 | +++ |
Bukhary 2018 [68] | Saudi Arabia | cross-sectional | 2015 | hospital | QFT-GIT | 520 | 56 | 10.8 | 8.4–13.7 | ++ |
El-Sokkary 2015 [69] | Egypt | cross-sectional | 2012–13 | chest hospital/nephrology ward | QFT-GIT | 132 | 38 | 28.8 | 21.7–37.1 | +++ |
Hefzy 2016 [70] | Egypt | cross-sectional | 2015–16 | hospital | QFT-GIT | 39 | 4 | 10.3 | 3.5–24.2 | ++ |
Talebi-Taher 2011 [71] | Iran | cross-sectional | 2009–10 | hospital | QFT-GIT | 200 | 17 | 8.5 | 5.3–13.3 | +++ |
Salmanzadeh 2016 [72] | Iran | cross-sectional | n/a | hospital | QFT-GIT | 87 | 27 | 31.0 | 22.3–41.4 | + |
Mostafavi 2016 [73] | Iran | cross-sectional | 2013–14 | laboratory | QFT-GIT | 244 | 42 | 17.2 | 13.0–22.5 | +++ |
Keshavarz Valian 2019 [74] | Iran | cross-sectional | 2016 | hospital | QFT-GIT | 101 | 47 | 46,5 | 37.1-56.2 | + |
Guanche Garcell 2014 [75] | Qatar (Cuban staff) | cross-sectional | 2012–13 | hospital | QFT-GIT | 202 | 6 | 3.0 | 1.2–6.5 | ++ |
Studies (n) | Prevalence (%) | 95% CI | |
---|---|---|---|
Europe | |||
All studies | 32 | 16.4 | 13.1–19.6 |
Study quality (+++/++) | 25 | 16.3 | 12.6–20.1 |
≥139 participants | 20 | 13.9 | 10.1–17.7 |
The Americas | |||
All studies | 5 | 16.5 | 9.8–23.2 |
Study quality (+++/++) | 3 | 19.3 | 1.6–36.9 |
≥139 participants | 4 | 14.9 | 7.8–22.0 |
North America | 3 | 4.5 | 3.8–5.2 |
Western Pacific | |||
All studies | 9 | 4.8 | 3.0–6.6 |
Study quality (+++/++) | 9 | 4.8 | 3.0–6.6 |
≥139 participants | 9 | 4.8 | 3.0–6.6 |
Eastern Mediterranean | |||
All studies | 11 | 19.4 | 13.0–25.7 |
Study quality (+++/++) | 9 | 16.1 | 9.5–22.7 |
≥139 participants | 7 | 15.2 | 7.9–22.6 |
WHO Region | Studies (n) | Job Category (n Events/n Total) | Total HCWs (n) | OR | 95% CI | I² (%) |
---|---|---|---|---|---|---|
Nurses | ||||||
All regions | 20 | 1072/7077 | 15,262 | 0.87 | 0.72–1.05 | 59 |
Europe | 10 | 608/4106 | 9099 | 0.80 | 0.63–1.02 | 56 |
Western Pacific | 4 | 52/1066 | 2102 | 0.85 | 0.58–1.26 | 0 |
Eastern Mediterranean | 6 | 412/1905 | 4061 | 1.01 | 0.74–1.38 | 53 |
Physicians | ||||||
All regions | 19 | 442/2492 | 15,130 | 1.01 | 0.76–1.36 | 67 |
Europe | 10 | 354/1616 | 9099 | 1.06 | 0.77–1.45 | 56 |
Western Pacific | 4 | 27/439 | 2102 | 1.09 | 0.50–2.39 | 50 |
Eastern Mediterranean | 5 | 61/437 | 3929 | 0.92 | 0.39–2.18 | 83 |
Lab workers | ||||||
All regions | 7 | 24/235 | 1732 | 1.01 | 0.58–1.77 | 28 |
Europe | 3 | 9/136 | 583 | 0.67 | 0.29–1.56 | 12 |
Western Pacific | 2 | 7/33 | 497 | 2.57 | 1.05–6.29 | 0 |
Eastern Mediterranean | 2 | 8/66 | 652 | 0.74 | 0.34–1.65 | 0 |
Administrations | ||||||
All regions | 7 | 222/901 | 10,145 | 1.60 | 1.18–2.17 | 37 |
Europe | 4 | 195/696 | 7369 | 1.69 | 1.06–2.67 | 58 |
Western Pacific | 1 | 6 /100 | 951 | 2.41 | 0.95–6.08 | na |
Eastern Mediterranean | 2 | 21 /75 | 1795 | 1.41 | 0.83–2.38 | 0 |
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Peters, C.; Kozak, A.; Nienhaus, A.; Schablon, A. Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries—A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 581. https://doi.org/10.3390/ijerph17020581
Peters C, Kozak A, Nienhaus A, Schablon A. Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries—A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2020; 17(2):581. https://doi.org/10.3390/ijerph17020581
Chicago/Turabian StylePeters, Claudia, Agnessa Kozak, Albert Nienhaus, and Anja Schablon. 2020. "Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries—A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 17, no. 2: 581. https://doi.org/10.3390/ijerph17020581