Tuberculosis in health care workers during declining tuberculosis incidence in New York State.
BACKGROUND
Nosocomial tuberculosis (TB) transmission has decreased dramatically in New York State since 1992; however, health care workers (HCWs) still compose >3% of TB cases.


METHODS
Aggregate surveillance data on incident TB cases from 1994 to 2002 were examined for trends among HCWs. Additional information was available for HCW cases from 1998 to 2002, including facility type, tuberculin skin test (TST) result at hire, and treatment of latent TB infection (TLTBI).


RESULTS
In New York State, 2.5% of TB cases in 1994 and 4.0% in 2002 were in HCWs (P value for trend <.001). Fifty percent of HCWs TB cases in 1994 and 77.6% in 2002 were in non-US born (P = .002) HCWs. Multidrug-resistant TB in HCWs decreased from 15.6% in 1994 to 6.9% in 2002 (P = .001). Of 297 HCWs TB cases in 1998-2002, 54.9% were TST positive at hire, and 21.2% had unknown TST result; 50.2% of 221 HCWs who were TST positive at or after hire met guidelines for TLTBI, and 23.4% received treatment. The highest proportion with unknown TST at hire and the lowest proportion receiving TLTBI were in ambulatory facilities.


CONCLUSIONS
Many HCWs who developed TB were either TST positive at hire and did not receive TLTBI or did not receive TST at hire. Facilities should encourage treatment for HCWs who meet criteria for TLTBI. Provider education should focus on ambulatory facilities.
Driver
Cynthia R
CR
Bureau of Tuberculosis Control, Department of Health and Mental Hygiene, New York, NY, USA. cdriver@health.nyc.gov
Stricof
Rachel L
RL
Granville
Karen
K
Munsiff
Sonal S
SS
Savranskaya
Galina
G
Kearns
Cheryl
C
Christie
Athalia
A
Oxtoby
Margaret
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D005260:Female; D006282:Health Personnel; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D009519:New York City / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology; D016273:Occupational Exposure; D014374:Tuberculin Test; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology*