Prevalence of Tuberculin Skin Test Positivity and Conversions Among Healthcare Workers in New York City During 1994 to 2001

Abstract

AbstractObjective:To determine the prevalence of and risk factors for tuberculin skin test positivity and conversion among New York City Department of Health and Mental Hygiene employees.Design:Point-prevalence survey and prospective cohort analysis. Sentinel surveillance was conducted from March 1,1994, to December 31, 2001.Participants:HCWs in high-risk and low-risk settings for occupational TB exposure.Results:Baseline tuberculin positivity was 36.2% (600 of 1,658), 15.5% (143 of 922) among HCWs born in the United States, and 48.5% (182 of 375) among HCWs not born in the United States. There were 36 tuberculin conversions during 2,754 observation-years (rate, 1.3 per 100 person-years). For HCWs born in the United States, the risk for tuberculin conversion was greater in high-risk occupational settings compared with low-risk settings (OR 5.7; CI95, 1.7–19.2;P< .01). HCWs not born in the United States and those employed at the Office of the Chief Medical Examiner (OCME) were at high risk for baseline tuberculin positivity (OR, 3.2; CI95,1.7–5.8;P< .001); OCME HCWs (OR 4.7; CI95, 2.3–9.4;P< .001), those of Asian ethnicity (OR 4.3; CI95,1.4–13.5;P< .01), and older HCWs (OR, 1.0; CI95,1.0–1.1;p< .05) were at a higher risk for conversion.Conclusions:Although the prevalence of tuberculin positivity decreased after the peak of the recent TB epidemic in New York City, the conversion rate among HCWs in high-risk occupational settings for TB exposure was still greater than that among HCWs in low-risk settings. Continued surveillance of occupational TB infection is needed, especially among high-risk HCWs.