Impact of WHO-Recommended TB Control Measures on Occupational TB Risk Among Healthcare Workers in a High-Burden Tertiary Hospital in Brazil: A 24-Year Retrospective Analysis.

Background: Tuberculosis (TB) remains a significant public health concern, particularly in low-to-middle-income countries. Healthcare workers (HCWs) are at a higher risk due to prolonged exposure. The World Health Organization (WHO) has proposed guidelines focusing on administrative interventions, structural interventions, and personal protective equipment (PPE) usage to mitigate this risk. Despite these recommendations, data on their efficiency in reducing occupational TB risk in Brazil is lacking.

Aim: Evaluate the effectiveness of the WHO-recommended measures regarding the risk of developing TB among the HCWs.

Methods: We conducted a retrospective analysis of TB incidence among patients admitted to a tertiary public Emergency Department (ED), and HCWs from 2000 to 2023. We extracted TB notifications among HCWs and the general population of Ribeirão Preto from a public database. We comparatively analysed the incidence rates between patients and HCWs to evaluate the effectiveness of WHO-recommended measures.

Findings: From 2000 to 2023, the ED handled an average of 148,496 patients per quadrennium, with 202 TB patients per quadrennium. The prevalence ratio of TB per 100,000 patients increased from 80 to 170 (p=0.035) and the incidence rates rose from 39 to 157 per 100,000 patients (p=0.046). The incidence rate of TB among HCWs in our institution started at 412.0 (85.0;1201.0) and decreased to 179.0 (20.0;619.0). In total, 11 HCWs were diagnosed with TB. The relative risk of having TB between HCWs and the general population was significantly higher before the Program implementation and became equivalent after it.

Conclusion: Implementing WHO-recommended TB control measures was demonstrated effective in reducing the incidence rate ratios between HCWs and the general population in a high-burden tertiary hospital in Brazil.