Preventing Tuberculosis (TB) in health workers and silica-exposed occupations

ABSTRACT

The COVID-19 pandemic has reminded us of the importance of workplace exposures and transmission in the control of airborne infectious diseases. The importance of workplace transmission of Tuberculosis (TB) has been well documented for decades, yet these past lessons have largely gone unheeded for health workers and silica-exposed occupations which are some of the highest risk subpopulations. It is estimated that health care workers who represent 3% of the global population made up 14% of reported COVID-19 and the same front-line workers are at three times greater risk for active TB compared to the general population. Despite these known risks, multiple studies have demonstrated that few health workers are provided with training or protections. Workplace TB prevention measures overlap with measures known to reduce the spread of COVID-19 and include improved ventilation, UV germicidal irradiation, personal protective equipment and training. These dual pandemics present an opportunity to refocus investment in Infection Prevention Control (IPC) measures in healthcare settings. Silica dust exposures and silicosis are known to significantly increase the risk of active TB among miners, construction workers and other exposed occupations. Reducing silica dust exposures has been shown to reduce TB incidence in high-risk workers. Recent studies have demonstrated that informal sector miners experience much higher rates of TB infection than large-scale miners. However, low-cost dust controls have been shown to reduce respirable silica dust by 80% which can have a large impact in reducing TB and silicosis. Workplace interventions to reduce TB in healthcare setting and among silica-exposed workers are cost effective and are considerably less expensive than treatment. The International Commission on Occupational Health (ICOH) has been taking an active role in working to increase recognition of workplace interventions to reduce TB transmission. Starting in 2017 the organization spear-headed efforts at the United Nations (UN) to gain recognition for workplace interventions in the General Assembly TB declaration (2018) and has since engaged with UN agencies, the World Bank and other global TB funding organizations. There is a considerable need to expand primary prevention in the workplace as part of the global TB response.