Cook Sharlette, Maw Khin Lay, Munsiff Sonal S, Fujiwara Paula I, Frieden Thomas R
New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, New York City, New York 10013, USA.
Infect Control Hosp Epidemiol. 2003 Nov;24(11):807-13. doi: 10.1086/502141.
To determine the prevalence of and risk factors for tuberculin skin test positivity and conversion among New York City Department of Health and Mental Hygiene employees.
Point-prevalence survey and prospective cohort analysis. Sentinel surveillance was conducted from March 1, 1994, to December 31, 2001.
HCWs in high-risk and low-risk settings for occupational TB exposure.
Baseline tuberculin positivity was 36.2% (600 of 1,658), 15.5% (143 of 922) among HCWs born in the United States, and 48.5% (182 of 375) among HCWs not born in the United States. There were 36 tuberculin conversions during 2,754 observation-years (rate, 1.3 per 100 person-years). For HCWs born in the United States, the risk for tuberculin conversion was greater in high-risk occupational settings compared with low-risk settings (OR, 5.7; CI95, 1.7-19.2; P < .01). HCWs not born in the United States and those employed at the Office of the Chief Medical Examiner (OCME) were at high risk for baseline tuberculin positivity (OR, 3.2; CI95, 1.7-5.8; P < .001); OCME HCWs (OR, 4.7; CI95, 2.3-9.4; P < .001), those of Asian ethnicity (OR, 4.3; CI95, 1.4-13.5; P < .01), and older HCWs (OR, 1.0; CI95, 1.0-1.1; P < .05) were at a higher risk for conversion.
Although the prevalence of tuberculin positivity decreased after the peak of the recent TB epidemic in New York City, the conversion rate among HCWs in high-risk occupational settings for TB exposure was still greater than that among HCWs in low-risk settings. Continued surveillance of occupational TB infection is needed, especially among high-risk HCWs.
确定纽约市卫生和精神卫生部门员工结核菌素皮肤试验阳性及转换的患病率和危险因素。
现患率调查和前瞻性队列分析。于1994年3月1日至2001年12月31日进行哨点监测。
职业性结核暴露高风险和低风险环境中的医护人员。
基线结核菌素阳性率为36.2%（1658人中600人），在美国出生的医护人员中为15.5%（922人中143人），非美国出生的医护人员中为48.5%（375人中182人）。在2754人年的观察期内有36例结核菌素转换（发生率为每100人年1.3例）。对于在美国出生的医护人员，与低风险环境相比，高风险职业环境中结核菌素转换的风险更高（比值比，5.7；95%可信区间，1.7 - 19.2；P <.01）。非美国出生的医护人员以及在首席法医办公室（OCME）工作的人员基线结核菌素阳性风险高（比值比，3.2；95%可信区间，1.7 - 5.8；P <.001）；OCME的医护人员（比值比，4.7；95%可信区间，2.3 - 9.4；P <.001）、亚洲族裔的医护人员（比值比，4.3；95%可信区间，1.4 - 13.5；P <.01）以及年长的医护人员（比值比，1.0；95%可信区间，1.0 - 1.1；P <.05）转换风险更高。
尽管纽约市近期结核病流行高峰后结核菌素阳性率有所下降，但结核暴露高风险职业环境中医护人员的转换率仍高于低风险环境中的医护人员。需要持续监测职业性结核感染情况，尤其是在高风险医护人员中。
