Intensive Tuberculosis Case Finding Activities

Background

The Risk of developing tuberculosis (TB) as an occupational disease is well established among Health Care Workers (HCWs) this risk is most likely due to frequent exposure to patients with both diagnosed and undiagnosed infectious Tb disease. The risk of ongoing transmission exists if patients have not been put on treatment yet, or if the treatment is ineffective. The transmission of TB to HCWs in health care settings has been reported from virtually every country of the world. Regardless of the local TB incidence. Studies from India have also shown a substantially higher TB incidence among health care workers. The risk of transmission varies by setting. Occupational group, the Tb burden, patient population and the effectiveness of TB infection control (TB IC measures).

Intervention

Intensified case finding activity was carried out in public sector health care workers of Gujarat, India with aim to diagnose undiagnosed TB cases in health institutes (PHC, CHC, SDH, DH and Medical College). Necessary permission was taken from respective departments of the State & Institute to under taken activity. Health care workers were mapped at their work places of health institute. Four symptoms complex (cough, fever, weight loss & night sweat) was applied to screen health workers by trained doctors. Positive in any symptom complex was asked to give sputum sample, which was tested on Xpert MTB/RIF assay as well as on X-ray chest PA view for those who got Mtb not detected result.

Results and Lesson Learnt

Out of total 1,47,701 total Health Care workers, around 92% were screened for any of four symptoms. 2,152 (2%) were identified as presumptive tuberculosis. 1,280 (59%) out of 2,152 presumptive tuberculosis subjected for Xpert MTB/RIF assay. It diagnosed 15 microbiologically confirmed tuberculosis cases and 2 clinical tuberculosis cases & 1 EPTB case. All tuberculosis cases were put on appropriate treatment regimen.

Conclusion

Screening HCWs at high risk of TB is likely to reduce transmission; and with earlier diagnosis & treatment, prevent serious illness & disability. Given the overall inadequate human resource for health, introducing screening of HCWs for TB is crucial. 

Source : We Care Coffee Table Book - Good, Replicable and Innovative Practices 2019