Tuberculosis among health care workers in British Columbia

OBJECTIVES: TO compare the clinical features and prevalence of active TB in British Columbia (BC) health-care workers (HCWs) with those of the general population, between 1991 and 1996. METHODS: Comparison of 25 HCWs and 50 controls randomly selected from the Centres for Disease Control registry, with respect to demographics, prevention, diagnosis and management. RESULTS: HCWs had fewer related risk factors, but more had initiated prior chemoprophylaxis (16% vs. 0%, P < 0.01) and knew their bacille Calmette-Guerin (BCG) (68% vs. 24%, P < 0.001) and purified protein derivative (PPD) status (60% vs 32%, P < 0.05). There were no differences in symptom duration (3.3 +/- 3.6 vs. 3.0 +/- 3.4 months), mycobacteriology and diagnostic features, treatment duration (264.9 +/- 63.9 vs. 239.0 +/- 78.7 days) and completion rates (84% for both). All HCWs used self-administered treatment (100% vs. 70%, P < 0.01), and fewer were hospitalized (8% vs. 28%, P < 0.05). Disease rates in nurses (3.6 +/- 4.4 per 100 000) were lower than the general population rates (9.0 +/- 0.8), but did not differ among physiotherapists (8.96 +/- 21.95), general practitioners (7.60 +/- 11.78) and medical residents (30.75 +/- 75.32). CONCLUSIONS: Clinical features were similar in HCWs, but management strategies differed. BC HCWs are not at increased risk of tuberculosis, but the small sample size limited the power of our study to detect such an increase.