Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand.
Occupational Health and Safety Office, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
Int J Environ Res Public Health. 2020 Sep 21;17(18):6876. doi: 10.3390/ijerph17186876.
Latent tuberculosis infection (LTBI) can develop into tuberculosis (TB). The WHO requires the discovery and management of LTBI among high-risk groups. Health care workers (HCWs) constitute a high-risk group. Factors associated with LTBI among HCWs in Thailand need further study. The current study aimed to explore the factors related to LTBI among Thai HCWs. A hospital-based, matched case-control study was conducted. All cases and controls were HCWs at a tertiary hospital in northeastern Thailand. Between 2017 and 2019, a total of 85 cases of interferon-γ release assays (IGRAs)-proven LTBI, and 170 control subjects were selected from a hospital (two controls per case). The two recruited controls were individually matched with LTBI cases by sex and age (±5 years). Secondary data were obtained from the occupational health and safety office. Case HCWs had a higher proportion of significant factors than control HCWs (i.e., working closely with pulmonary TB-94.1% vs. 88.8%, and working in the area of aerosol-generating procedures (AGPs) 81.2% vs. 69.4%). The bivariate conditional logistic regression showed that the occurrence of LTBI in HCWs was statistically significant (-value < 0.05), particularly with respect to: workplaces of AGPs (crude OR = 1.90, 95% CI: 1.01-3.58, = 0.041); among HCWs performing AGPs (crude OR = 2.04, 95% CI: 1.20, 3.48, = 0.007); and, absent Bacille Calmette-Guérin (BCG) scar (crude OR = 2.59, 95% CI: 1.50-4.47, = 0.001). Based on the multivariable conditional logistics analysis, HCWs who performed AGPs while contacting TB cases had a statistically significant association with LTBI (adjusted OR = 1.82, 95% CI: 1.04-3.20, = 0.035). HCWs who reported the absence of a BCG scar had a statistically significant association with LTBI (adjusted OR = 2.49, 95% CI: 1.65-5.36, = 0.001), whereas other factors including close contact with TB (adjusted OR = 2.44, 95% CI: 0.74, 8.09, = 0.123) were not significantly associated with LTBI. In conclusion, HCWs who performed AGPs and were absent a BCG scar had a significant association with LTBI, while other factors played a less critical role.
潜伏性结核感染(LTBI)可发展为结核病(TB)。世界卫生组织要求在高危人群中发现和管理 LTBI。医护人员(HCWs)构成高危人群。泰国 HCWs 中与 LTBI 相关的因素需要进一步研究。本研究旨在探讨泰国 HCWs 中与 LTBI 相关的因素。这是一项基于医院的病例对照研究。所有病例和对照均为泰国东北部一家三级医院的 HCWs。在 2017 年至 2019 年间,从医院共选择了 85 例干扰素-γ释放试验(IGRAs)证实的 LTBI 病例和 170 例对照(每个病例 2 例对照)。从职业健康和安全办公室获得了二次数据。病例组 HCWs 中具有显著意义的因素比例高于对照组 HCWs(与肺结核密切接触的比例分别为 94.1%和 88.8%,以及从事气溶胶产生程序(AGPs)的比例分别为 81.2%和 69.4%)。双变量条件逻辑回归显示,HCWs 中 LTBI 的发生具有统计学意义(-值<0.05),特别是在以下方面:AGPs 工作场所(粗比值比=1.90,95%可信区间:1.01-3.58,=0.041);从事 AGPs 的 HCWs(粗比值比=2.04,95%可信区间:1.20-3.48,=0.007);和,无卡介苗(BCG)疤痕(粗比值比=2.59,95%可信区间:1.50-4.47,=0.001)。基于多变量条件逻辑分析,与 TB 病例接触时从事 AGPs 的 HCWs 与 LTBI 具有统计学显著关联(调整比值比=1.82,95%可信区间:1.04-3.20,=0.035)。报告无 BCG 疤痕的 HCWs 与 LTBI 具有统计学显著关联(调整比值比=2.49,95%可信区间:1.65-5.36,=0.001),而其他因素,包括与 TB 的密切接触(调整比值比=2.44,95%可信区间:0.74-8.09,=0.123)与 LTBI 无显著关联。总之,从事 AGPs 且无 BCG 疤痕的 HCWs 与 LTBI 有显著关联,而其他因素的作用则较小。