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Estimating prevalence among HCWs is therefore essential for informing infection control strategies. In Saudi Arabia, infection risk may be influenced by the multinational composition of the healthcare workforce and differing baseline TB exposure across countries of origin. Heterogeneous Bacillus Calmette\u2013Gu\u00e9rin (BCG) vaccination histories may also introduce diagnostic bias in studies relying on the tuberculin skin test (TST). However, existing studies are predominantly single-center or regional, employ heterogeneous diagnostic methods, and report inconsistent prevalence estimates, precluding a national-level synthesis. Accordingly, we conducted a systematic review and meta-analysis to estimate LTBI prevalence among HCWs in Saudi Arabia and to examine factors associated with infection risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines. MEDLINE (via PubMed), Web of Science, Google Scholar, and the Elton B. Stephens Company (EBSCO) databases were searched up to March 2025 (final search conducted in March 2025), without applying a lower date limit, for observational studies reporting LTBI prevalence among adult HCWs in Saudi Arabia. LTBI was diagnosed using tuberculin skin tests or interferon-gamma release assays. Random-effects models were used to estimate pooled prevalence and to derive odds ratios from within-study subgroup comparisons. Pre-specified subgroup analyses explored potential sources of heterogeneity by nationality, occupation, sex, and age. Methodological quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS) and the Methodological Index for Non-Randomized Studies (MINORS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eleven studies comprising 11,249 HCWs were included. The pooled prevalence of LTBI was 24% (95% CI: 16\u201333%), with substantial heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200999%). Sensitivity analysis excluding one high-prevalence study reduced the pooled estimate to 19%. Subgroup analyses showed that Saudi HCWs had significantly lower odds of LTBI compared with non-Saudi HCWs (OR\u2009=\u20090.31, 95% CI: 0.21\u20130.46). Nurses had higher odds of LTBI than technicians (OR\u2009=\u20091.40, 95% CI: 1.07\u20131.83), while no significant differences were observed between nurses and physicians or between male and female HCWs. LTBI prevalence varied across age categories, from 16% among HCWs younger than 30\u00a0years to 26% among those aged 50\u00a0years or older.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      LTBI remains a significant occupational health concern among HCWs in Saudi Arabia, with higher prevalence observed among non-Saudi staff and nurses. However, the available evidence does not allow these differences to be attributed to specific causes, as key factors such as country of origin, BCG status, and non-occupational exposure were not consistently reported. Strengthened TB control policies, including standardised screening protocols, fit-testing, and consistent protective measures, are needed to improve early detection and reduce transmission risk\n                      <jats:italic>.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-026-27751-0","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T09:24:41Z","timestamp":1780305881000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence of latent tuberculosis infection among healthcare workers in Saudi Arabia: a systematic review and meta-analysis"],"prefix":"10.1186","volume":"26","author":[{"given":"Yousef N.","family":"Alanazi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afnan M.","family":"Alotaibi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa Saeed","family":"Bahakam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Batool Awad","family":"Leslom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raghad Ahmed","family":"Al Juhani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdalazez Mohammed","family":"Altayyar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad Yahya","family":"Alsayed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsenah Jaber","family":"Alfaifi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"27751_CR1","doi-asserted-by":"publisher","first-page":"12764","DOI":"10.1038\/s41598-021-92200-1","volume":"11","author":"HM Semilan","year":"2021","unstructured":"Semilan HM, Abugad HA, Mashat HM, Abdel Wahab MM. 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This study was a systematic review and meta-analysis of previously published studies.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"2339"}}