Menzies D, Joshi R, Pai M
Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Canada.
Int J Tuberc Lung Dis. 2007 Jun;11(6):593-605.
Tuberculosis (TB) in health care workers (HCWs) was not considered a serious problem following the advent of effective antibiotic therapy. Interest was re-stimulated by the occurrence of several major nosocomial outbreaks.
We have reviewed the available published literature regarding prevalence and incidence of TB infection and disease among HCWs in countries categorised by mean income. We included studies published in English since 1960 from low- and middle-income countries (LMICs) and since 1990 from high-income countries (HICs). We excluded outbreak reports and studies based only on questionnaires.
The median prevalence of latent TB infection (LTBI) in HCWs was 63% (range 33-79%) in LMICs and 24% in HICs (4-46%). Among HCWs from LMICs, LTBI was consistently associated with markers of occupational exposure, but in HICs it was more often associated with non-occupational factors. The median annual incidence of TB infection attributable to health care work was 5.8% (range 0-11%) in LMICs and 1.1% (0.2-12%) in HICs. Rates of active TB in HCWs were consistently higher than in the general population in all countries, although findings were variable in HICs. Administrative infection control measures had a modest impact in LMICs, yet seemed the most effective in HICs.
TB remains a very important occupational risk for HCWs in LMICs and for workers in some institutions in HICs. Risk appears particularly high when there is increased exposure combined with inadequate infection control measures.
随着有效抗生素疗法的出现，医护人员中的结核病曾不被视为严重问题。几起重大医院内暴发事件重新激发了人们对此的关注。
我们回顾了按平均收入分类的各国医护人员中结核病感染和发病的患病率及发病率的现有已发表文献。我们纳入了自1960年以来来自低收入和中等收入国家（LMICs）以及自1990年以来来自高收入国家（HICs）以英文发表的研究。我们排除了暴发报告和仅基于问卷调查的研究。
低收入和中等收入国家医护人员中潜伏性结核感染（LTBI）的患病率中位数为63%（范围33 - 79%），高收入国家为24%（4 - 46%）。在来自低收入和中等收入国家的医护人员中，LTBI始终与职业暴露标志物相关，但在高收入国家，它更常与非职业因素相关。低收入和中等收入国家中因医护工作导致的结核感染年发病率中位数为5.8%（范围0 - 11%），高收入国家为1.1%（0.2 - 12%）。所有国家医护人员中的活动性结核发病率始终高于普通人群，尽管高收入国家的研究结果存在差异。行政性感染控制措施在低收入和中等收入国家有适度影响，但在高收入国家似乎最有效。
结核病仍然是低收入和中等收入国家医护人员以及高收入国家一些机构工作人员面临的非常重要的职业风险。当暴露增加且感染控制措施不足时，风险似乎特别高。
