title: Are healthcare workers in England and Wales at increased risk of tuberculosis?
abstract: OBJECTIVE
  To determine whether healthcare workers in England and Wales are at increased risk of tuberculosis and to examine the frequency of drug resistance in this population.
  
  
  METHODS
  Comparison of notification rates by occupation obtained from national tuberculosis notification surveys in 1988 and 1993, with denominators from the 1991 census.
  
  
  METHODS
  People with notified tuberculosis in professional and associate professional occupations from the two surveys.
  
  
  METHODS
  Rates of notified tuberculosis in health professionals (mainly doctors) and health associate professionals (mainly nurses) compared with rates in other professional and associate professional occupations, adjusted for ethnic group, sex, and age.
  
  
  RESULTS
  119 cases of tuberculosis were identified in healthcare workers, including 61 nurses and 42 doctors. The crude notification rate in healthcare workers was 11.8 per 100,000 per year (95% confidence interval 9.8 to 14.1) compared with 3.3 per 100,000 per year (2.9 to 3.6) in other professional and associate professional occupations; rate ratios were higher (range 1.7 to 3.2) in all ethnic groups. The relative risk adjusted for ethnic group, sex, and age was 2.4 (95% confidence interval 2.0 to 3.0), slightly higher for health professionals (2.7 (1.9 to 3.8)) than for associate professionals (2.0 (1.5 to 2.6)). No multiple drug resistant strains of tuberculosis were identified in healthcare workers.
  
  
  CONCLUSIONS
  Better detection and notification of cases of tuberculosis in healthcare workers may account for some of the apparent increased risk, but these findings imply that tuberculosis remains a hazard for healthcare workers and highlight the importance of ensuring that occupational health monitoring and protection workers are not neglected.
authors.affiliation: Department of Epidemiology and Medical Statistics, London Hospital Medical College. sarah.meredith@mcmail.vanderbilt.edu
authors.forename: S
authors.initials: S
authors.lastname: Meredith
authors.forename: J M
authors.initials: JM
authors.lastname: Watson
authors.forename: K M
authors.initials: KM
authors.lastname: Citron
authors.forename: A
authors.initials: A
authors.lastname: Cockcroft
authors.forename: J H
authors.initials: JH
authors.lastname: Darbyshire
mesh_terms: D018563:Disease Notification; D004739:England / Q000453:epidemiology; D005260:Female; D006282:Health Personnel; D006801:Humans; D015994:Incidence; D008297:Male; D009784:Occupational Diseases / Q000453:epidemiology*; D012307:Risk Factors; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology; D014852:Wales / Q000453:epidemiology