Evaluating a framework for tuberculosis screening among healthcare workers in clinical settings, Inner Mongolia, China
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RESEARCH
Open Access
Evaluating a framework for tuberculosis screening among healthcare workers in clinical settings, Inner Mongolia, China Shiming Cheng1†, Deanna Tollefson2†, Guangxue He1†, Yuan Li3†, Hui Guo1, Shua Chai2,3, Fangfang Gao4, Fei Gao4, Guoxin Han4, Liping Ren4, Yulin Ren4, Jianbo Li5, Lixia Wang1, Jay K. Varma2,3, Dongmei Hu1, Haiying Fan1, Fei Zhao1, Emily Bloss2, Yu Wang1* and Carol Y. Rao2,3*
Abstract Background: Health care workers are at high risk for tuberculosis (TB). China, a high burden TB country, has no policy on medical surveillance for TB among healthcare workers. In this paper, we evaluate whether China’s national TB diagnostic guidelines could be used as a framework to screen healthcare workers for pulmonary TB disease in a clinical setting in China. Methods: Between April–August 2010, healthcare workers from 28 facilities in Inner Mongolia Autonomous Region, China were eligible for TB screening, comprised of symptom check, chest X-ray and tuberculin skin testing. Healthcare workers were categorized as having presumptive, confirmed, or clinically-diagnosed pulmonary TB, using Chinese national guidelines. Results: All healthcare workers (N=4347) were eligible for TB screening, of which 4285 (99%) participated in at least one TB screening test. Of the healthcare workers screened, 2% had cough for ≥ 14 days, 3% had a chest Xray consistent with TB, and 10% had a tuberculin skin test induration ≥ 20 mm. Of these, 124 healthcare workers were identified with presumptive TB (i.e., cough for ≥ 14 days in the past 4 weeks or x-ray consistent with TB). Twelve healthcare workers met the case definition for clinically-diagnosed pulmonary TB, but none were diagnosed with TB during the study period. Conclusion: A substantial proportion of healthcare workers in Inner Mongolia had signs, symptoms, or test results suggestive of TB disease that could have been identified using national TB diagnostic guidelines as a screening framework. However, achieving medical surveillance in China will require a framework that increases the ease, accuracy, and acceptance of TB screening in the medical community. Routine screening with improved diagnostics should be considered to detect tuberculosis disease among healthcare workers and reduce transmission in health care settings in China. Keywords: Case detection, Medical surveillance, Clinically diagnosed cases, Active case finding, Healthcare workers, X-ray, Tuberculosis, Tuberculin skin test
* Correspondence: [email protected]; [email protected] † Equal contributors 1 China Center for Disease Control and Prevention, 155 Changbai Road Changping District, Beijing 102206, People’s Republic of China 2 U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road NE, MS-93, Atlanta, GA 30329, USA Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which per
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