TB Risk Higher Among Health Care Workers in South Africa, New Study Finds
Health care workers in South Africa are at increased risk of acquiring drug-resistant tuberculosis — a transmission pattern that should be addressed through policies that prioritize occupational risk reduction for health care workers, according to a new study co-authored by a Boston University School of Public Health researcher.
The study by a team including BUSPH Epidemiology Chair C. Robert Horsburgh, published Oct. 19 in the Annals of Internal Medicine, found that health workers in KwaZulu-Natal province, South Africa — which has high rates of multidrug-resistant tuberculosis (TB) — were more than five times more likely to be hospitalized for TB than non-healthcare workers.
Recent studies indicate that hospital-based transmission of TB is a potentially important factor in the spread of multidrug-resistant TB.
“This study has implications for policymaking and the organization of health services in countries with endemic drug-resistant tuberculosis,” the authors wrote. “Health care workers have a statistically significant higher risk for drug-resistant tuberculosis compared with the general population, and this should be addressed in policies for occupational risk reduction and infection control…
“Policy measures that prioritize health care worker protection and risk may be critical for tuberculosis control in resource-constrained countries with endemic drug-resistant tuberculosis.”
The research team studied admissions records for more than 4,000 patients who were hospitalized in the province to receive treatment for drug-resistant TB. Patients were asked to indicate whether they were health care workers at the time of hospitalization.
Tuberculosis is a highly infectious disease that may be transmitted if droplets coughed or sneezed by an infected person are inhaled by another person. The high rate of TB infection in South Africa is complicated in many patients, who have strains of the disease that are resistant to certain antibiotics. Every year, an estimated 500,000 people develop drug-resistant tuberculosis, which can lead to death.
A recently updated guideline on TB infection control for health care workers in hospitals and congregate settings, published in 2009 by the World Health Organization, recommends prioritizing tuberculosis control on the national level. The guideline includes recommendations for implementing ongoing surveillance of tuberculosis disease among health care workers and monitoring and evaluating infection-control measures.
Horsburgh, who has researched tuberculosis for more than 25 years, is chairman of the steering committee of a large consortium called Research Excellence to Stop TB Resistance — or RESIST-TB — which is working to develop and promote clinical trial protocols for studies on drug efficacy and treatment for drug-resistant TB.
Other authors of the new study include researchers from the Centre for AIDS Programme of Research in South Africa; University of KwaZulu-Natal, Durban, South Africa; University of Calgary, Canada; Medical Research Council, Cape Town, South Africa; Salem State College School of Social Work, Salem, Ma.; King George V Hospital, Sydenham, South Africa; Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia; University College, London; and McGill University, Montreal.
Read the study on The Annals of Internal Medicine website.
Submitted by Lisa Chedekel