title: Tuberculosis in Healthcare Workers: A Matched Cohort Study in Taiwan.
abstract: BACKGROUND
  Proportional mortality ratio data indicate that healthcare workers (HCWs) have an elevated tuberculosis (TB) mortality. Whether this is caused by an increased TB incidence, a worse TB treatment outcome, or a combination of effects, remains unclear. To elucidate the hazard components of occupational TB, we assessed TB incidence and TB treatment outcome among HCWs in Taiwan.
  
  
  METHODS
  We compared the incidence of active TB among HCWs at a major medical center in Taiwan with that of Taiwan general population in 2004-2012. We also compared the TB treatment outcome of HCWs with that of age/sex-matched non-HCW patients treated at the same hospital, as well as that of nationally registered TB patients.
  
  
  RESULTS
  The standardized TB incidence ratio of the HCWs was 1.9 (95% confidence interval [CI]: 1.2-2.9), compared with the general population. HCWs with pulmonary TB (n = 30) were less likely to have underlying diseases, delay in diagnosis, delay in treatment, or side effects of treatment, compared with age/sex-matched non-HCW TB patients (n = 120) (all Ps<0.05). The TB treatment outcome of HCWs was significantly better than that of non-HCW patients (TB-related mortality: 0.0% vs. 5.8%, P = 0.008, Mantel-Haenszel test). The standardized TB-related mortality rate was 1.08% [95% CI: 0.96% - 1.20%] for all of the nationally registered TB patients in Taiwan.
  
  
  CONCLUSIONS
  HCWs are at increased risk of active TB, compared with general population. To mitigate this occupational hazard, more efforts need to be directed towards the prevention of nosocomial TB transmission. Healthy worker effect, more rapid diagnosis, and less delay in treatment contribute to a lower TB-related mortality in HCWs.
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Sung-Ching
authors.initials: SC
authors.lastname: Pan
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jann-Yuan
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wang-Huei
authors.initials: WH
authors.lastname: Sheng
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Hsien-Ho
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chi-Tai
authors.initials: CT
authors.lastname: Fang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013624:Taiwan; D014376:Tuberculosis / Q000453:epidemiology* / Q000401:mortality