Latent tuberculosis in healthcare workers: time to act.

Issa Al Jahdhami (MD, MRCP) Senior Consultant, Chest Physician. Armed Forces Hospital, Department of Medicine, Muscat, Sultanate of Oman, PO Box 282 PC 124. E-mail: [email protected] Reactivation of Latent Tuberculosis is an important source of active infection with Mycobacterium tuberculosis. Thus, testing for latent TB is one of the important steps in the control of TB disease around the world. Healthcare workers (HCWs) are at risk of acquiring TB from contact with infected patients they care for in the case of nurses and physicians or from exposure to infected specimens in the case of laboratory workers. This article aims to highlight the possibility of testing HCWs in Oman for latent TB and offering them prophylactic treatment to reduce their risk of developing active disease in the future. Tuberculosis (TB) remains an important infectious disease that claims a great number of mortalities around the world despite progress in medical knowledge and management. In Oman, the National TB program was started in 1981 and was initially aimed at controlling TB and more recently, to eliminate the disease from the country.1 As part of the national vaccination program, Bacillus Calmette-Guerin (BCG) vaccination is given at birth to all newborns. Latent TB Infection (LTBI) is diagnosed when the patient has evidence of TB infection either by positive Mantoux Tuberculin skin test (TST) or more recently by a positive interferon gamma release assays (IGRAs) with no clinical or radiological evidence for active disease.2 Patients are usually asymptomatic and they tend not to be contagious. Reactivation of LTBI is one of the major causes of the development of new cases of active TB in low prevalence countries like Oman.3,4 Hence, it is important to identify and treat LTBI if we aim to attain total control of TB in the country.4 To date, there are no national guidelines for screening or management of LTBI in Oman. Currently, treatment for LTBI is only offered for contacts of open pulmonary TB cases. Healthcare workers (HCWs) are at risk of infection with TB in view of their constant exposure to infected patients.5 Inadequate use of preventative measures like N95 masks, poor ventilation at the work place, exposure during procedures like sputum induction and bronchoscopy are other risk factors.6 One of the aims of testing for latent TB is to raise HCWs awareness about the possibility of acquiring infection from patients if proper precautions are not taken, it is presumed that HCWs who test positive for LTBI will become more careful and adhere more to infection control Oman Medical Journal (2013) Vol. 28, No. 2:146-148 DOI 10. 5001/omj.2013.39