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Risk of tuberculosis transmission among healthcare workers

Roland Diel, Stefan Niemann, Albert Nienhaus
ERJ Open Research 2018 4: 00161-2017; DOI: 10.1183/23120541.00161-2017
Roland Diel
1Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany
2LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Germany
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  • ORCID record for Roland Diel
Stefan Niemann
3Molecular and Experimental Mycobacteriology Group, Reference Center for Mycobacteria, Research Center Borstel, Borstel, Germany
4German Center for Infection Research, Borstel, Germany
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Albert Nienhaus
5Institute for Health Service Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
6Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
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  • FIGURE 1
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    FIGURE 1

    Clustering of healthcare workers (HCWs) and patterns of transmission.

  • FIGURE 2
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    FIGURE 2

    a) IS6110 restriction fragment length polymorphism (RFLP) and b) spoligotyping patterns of a multidrug-resistant tuberculosis (MDR-TB) cluster. Identical IS6110 RFLP and spoligotyping patterns of the isolates of 11 MDR-TB cluster members. Two male prostitutes (strain no. 8210/12 and no. 9167/12) each infected one healthcare worker (strain no. 2090/14 and 10392/14) in a facility for street sex workers.

Tables

  • Figures
  • TABLE 1

    Univariate analysis of risk factors for patients belonging to IS6110 restriction fragment length polymorphism clusters

    Non-cluster groupCluster groupAll patientsp-value
    Patients14759182393
    Age years47.3±19.537.6±16.545.9±19.4<0.001
    AIDS110 (7.5)65 (7.1)175 (7.3)ns
    Resistance to any drug165 (11.2)79 (8.6)244 (10.2)0.04
    Beijing genotype99 (6.7)61 (6.6)160 (6.7)ns
    Foreign-born987 (66.9)422 (46.0)1409 (58.9)<0.001
    Male/female851/624 (57.7/42.3)619/299 (67.4/32.6)1470/923 (61.4/38.6)<0.001
    Drug abuse36 (2.4)90 (9.8)126 (5.3)<0.001
    Alcohol abuse121 (8.2)313 (34.1)434 (18.1)<0.001
    Homelessness93 (6.3)124 (13.5)217 (9.1)<0.001
    Sputum smear positivity474 (32.1)447 (48.7)921 (38.5)0.001
    Previous history of TB165 (11.2)98 (10.7)263 (11.0)ns
    Unemployment371 (25.2)427 (46.5)798 (33.3)<0.001
    Healthcare worker26 (1.8)29 (3.2)55 (2.3)0.027

    Data are presented as n, mean±sd or n (%), unless otherwise stated. % refers to the total number of tuberculosis (TB) patients in the non-cluster or cluster group. ns: nonsignificant.

    • TABLE 2

      Results of multiple logistic regression of risk factors for epidemiologically confirmed transmission in tuberculosis cluster patients

      Odds ratio (95% CI)p-value
      Healthcare worker3.07 (1.59–5.92)0.001
      Alcohol abuse2.30 (1.66–3.18)<0.001
      Sputum smear positivity1.79 (1.39–2.32)<0.001
      Drug addiction (i.v.)1.12 (0.71–1.78)0.62
      Unemployment1.18 (0.88–1.60)0.27
      Male1.23 (0.92–1.65)0.16
      Any drug resistance0.86 (0.55–1.36)0.52
      Homelessness0.995 (0.64–1.42)0.98
      Age0.96 (0.95–0.97)<0.001
      Foreign born0.36 (0.27–0.48)<0.001
    • TABLE 3

      Examples of clusters “imported” to Hamburg

      Age yearsSexOrganCountry of birthDate of diagnosisLatency to diagnosis of TB
      disease after immigration
      A48MaleTB of cervical lymph nodesTurkeyFebruary 7, 199826 weeks
      66MaleSputum smear-positive culture-
      confirmed TB
      TurkeyFeburary 26, 199820 weeks
      B23MaleSputum smear-negative culture-
      confirmed TB
      TurkeySeptember 14, 19982 days
      39FemaleSputum smear-negative culture-
      confirmed TB
      TurkeyFebruary 4, 19994 weeks
      C4MaleSputum smear-negative culture-
      confirmed TB
      AfghanistanMay 7, 19971 day
      18FemaleUrogenital TBAfghanistanJune 7, 19992 weeks
      D40MaleSputum smear-negative culture-
      confirmed TB
      AfghanistanJanuary 27, 19982 weeks
      59FemaleTB of cervical lymph nodesAfghanistanMarch 9, 1999150 weeks
      E37MaleSputum smear-positive culture-
      confirmed TB
      RomaniaApril 23, 20070 weeks (diagnosis at entry)
      21MaleSputum smear-positive culture-
      confirmed TB
      RomaniaJuly 28, 201131 weeks

      TB: tuberculosis.

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      Risk of tuberculosis transmission among healthcare workers
      Roland Diel, Stefan Niemann, Albert Nienhaus
      ERJ Open Research Apr 2018, 4 (2) 00161-2017; DOI: 10.1183/23120541.00161-2017

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      Risk of tuberculosis transmission among healthcare workers
      Roland Diel, Stefan Niemann, Albert Nienhaus
      ERJ Open Research Apr 2018, 4 (2) 00161-2017; DOI: 10.1183/23120541.00161-2017
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