Buchancová J, Svihrová V, Legáth L, Bátora I, Záborský T, Rozborilová E, Fenclová Z, Urban P, Zibolenová J, Osina O, Janoušek M, Hudečková H
Epidemiol Mikrobiol Imunol. 2014 Sep;63(3):200-5.
To conduct a retrospective 15-year study to monitor trends in the number of employees at risk for occupational tuberculosis (TB) (levels III and IV) in the Slovak Republic, and in particular in the sector of economic activities Q (health care and social assistance). Furthermore, to analyze reported cases of occupational TB and to compare the incidence and sex-specific and age-specific prevalence with the data reported in the Czech Republic.
Data on the number of employees at risk of exposure to occupational TB were derived from the Automated Risk Classification System of the Slovak Republic. Data on cases of occupational TB were taken from health statistics (Institute of Health Information and Statistics/National Health Information Center in the Slovak Republic and the National Institute of Public Health in the Czech Republic). A retrospective analysis was conducted (for 1998-2012) of reported cases of occupational TB, selected from Article 24 of the List of occupational diseases (infectious and parasitic diseases except tropical infectious and parasitic diseases and diseases transmissible from animals to humans). The selection criterion was a TB diagnosis according to ICD-10. In the Czech Republic, the data were derived from Article 5.1.02 (tuberculosis), Chapter V. of the List of Occupational Diseases. The data obtained were analyzed by methods of descriptive statistics.
The numbers of employees with a level III risk of exposure to occupational TB in the Slovak Republic declined by 30% over the 15 years of study and by 40% in category Q. In 2012, 2027 employees were classified in category III and 1442 of them belonged to group Q. Females accounted for 81-84% of employees at risk of exposure to occupational TB. Eighty-six and 181 cases of occupational TB were reported in the Slovak Republic and in the Czech Republic, respectively, in 1998-2012, with the incidence showing a downward trend in both countries. TB of the respiratory tract was reported most often (83.7% of the total of reported cases of occupational TB). As expected, more cases occurred in females than in males (1.9 times as many cases in females as in males in the Slovak Republic and three times as many cases in females as in males in the Czech Republic). The incidence of occupational TB was the highest in sector Q, with the highest absolute numbers reported in nurses. In 2012, the incidence rates of occupational TB were 0.22 cases per 100,000 sick benefit policy holders in the Slovak Republic and 0.13 cases per 100,000 sick benefit policy holders in the Czech Republic.
The incidence of occupational TB has a downward trend in both countries, similarly to TB incidence in the general population. A negative aspect in both countries is the incidence of occupational TB at the middle productive age, in contrast to the population occupationally non-exposed to TB. Slovakia is surrounded by higher prevalence countries, with the exception of the Czech Republic. It cannot be ruled out that, in addition to the known factors influencing the prevalence of TB, including occupational TB, migration from eastern countries, including job search migration, can also play a role in increase in TB cases. It is vital to continue epidemiological surveillance and to reduce the risk of TB as much as possible also in healthcare settings by adhering to barrier nursing practices. Cases of active TB need early and adequately long, controlled treatment in order to reduce, among others, the incidence of multi-drug resistant TB.
开展一项为期15年的回顾性研究，以监测斯洛伐克共和国面临职业性结核病（TB）风险（III级和IV级）的员工数量趋势，特别是经济活动Q部门（医疗保健和社会援助）的此类趋势。此外，分析报告的职业性结核病病例，并将发病率以及按性别和年龄划分的患病率与捷克共和国报告的数据进行比较。
面临职业性结核病暴露风险的员工数量数据来自斯洛伐克共和国的自动风险分类系统。职业性结核病病例数据取自健康统计资料（斯洛伐克共和国健康信息与统计研究所/国家健康信息中心以及捷克共和国国家公共卫生研究所）。对1998 - 2012年报告的职业性结核病病例进行回顾性分析，这些病例选自职业病列表（传染病和寄生虫病，不包括热带传染病和寄生虫病以及动物传染给人的疾病）第24条。选择标准是根据国际疾病分类第10版（ICD - 10）做出的结核病诊断。在捷克共和国，数据源自职业病列表第五章第5.1.02条（结核病）。所获数据采用描述性统计方法进行分析。
在为期15年的研究中，斯洛伐克共和国面临III级职业性结核病暴露风险的员工数量下降了30%，经济活动Q部门下降了40%。2012年，有2027名员工被归类为III级，其中1442名属于Q组。女性占面临职业性结核病暴露风险员工的81 - 84%。1998 - 2012年期间，斯洛伐克共和国和捷克共和国分别报告了86例和181例职业性结核病病例，两国的发病率均呈下降趋势。呼吸道结核病报告最为常见（占报告的职业性结核病病例总数的83.7%）。不出所料，女性病例多于男性（斯洛伐克共和国女性病例是男性的1.9倍，捷克共和国女性病例是男性的3倍）。职业性结核病发病率在经济活动Q部门最高，护士报告的绝对病例数最多。2012年，斯洛伐克共和国每10万名疾病津贴政策持有者中的职业性结核病发病率为0.22例，捷克共和国为每10万名疾病津贴政策持有者0.13例。
两国职业性结核病发病率均呈下降趋势，与普通人群的结核病发病率情况类似。两国的一个不利方面是处于生产年龄中期的职业性结核病发病率，这与未接触结核病的人群情况形成对比。除捷克共和国外，斯洛伐克周边国家结核病患病率较高。除了包括职业性结核病在内的已知影响结核病患病率的因素外，不能排除来自东方国家的移民，包括求职移民，也可能在结核病病例增加中起作用。持续进行流行病学监测并通过坚持屏障护理措施在医疗机构中尽可能降低结核病风险至关重要。活动性结核病病例需要尽早且进行足够长时间的规范治疗，以减少尤其是耐多药结核病的发病率。
