TUBERCULOSIS IN NATIONAL-HEALTH-SERVICE HOSPITAL STAFF IN THE WEST MIDLANDS REGION OF ENGLAND, 1992-5

Background - This study was designed to assess the current incidence o f tuberculosis (TB) in National Health Service hospital staff in the W est Midlands region of England and to evaluate the effectiveness of oc cupational health screening and surveillance procedures. Methods - A f our year prospective study (1992-5) was carried out with case ascertai nment through occupational health departments and the Midlands Thoraci c Society registry of rare respiratory diseases. Results No case was k nown to an occupational health department that was not notified by the registry and, in addition, the registry yielded a further six cases. There were 26 cases of active TB, of which 24 presented with symptoms and 12 had no pre-employment screening. All except one doctor were for eign born - mainly from the Indian subcontinent (ISC) - and of recent UK entry, whilst all except one nurse were white females. The followin g are annual TB incidences per 10(4) (95% confidence interval): ISC an d non-white doctors 17.0 (7.8 to 26.2), not significantly greater than in the local ISC and nonwhite social class 1 working age population ( 11.8 (8.5 to 15.1)); white nurses 0.6 (0.2 to 1.0), significantly grea ter (p<0.05) than that of white women in the local social class 2 work ing age population (0.2 (0.1 to 0.3)); others (mortuary attendant, phy siotherapist, radiographer and theatre technician) 1.0 (0.02 to 2.0), not significantly greater than in the local social class 2 working age population (0.6 (0.5 to 0.7)). Conclusions - Case ascertainment via t he registry was complete. Most cases of TB were in nurses and doctors, more commonly in doctors. However, all but one of the doctors were fo reign born and probably had reactivation of infection acquired abroad rather than infection occupationally acquired in the UK. All but one o f the nurses, however, were UK born and may have had occupationally ac quired disease, their incidence being higher than in the community. As most cases present with symptoms, there needs to be continued emphasi s on prompt reporting of suspicious symptoms both before and during em ployment, and pre-employment BCG vaccination where appropriate.