{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T01:21:35Z","timestamp":1788312095129,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2020,6,28]],"date-time":"2020-06-28T00:00:00Z","timestamp":1593302400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Latent tuberculosis infection (LTBI) represents a work-related risk for health workers (HWs). Tuberculosis remains the second most common occupational infectious disease among HWs in Germany. Comparative figures on LTBI prevalence in the general population are missing because testing is only carried out in the context of an outbreak situation. The objective of this study is to investigate whether HWs are at greater risk of LTBI than workers in other sectors. This study is based on two samples. The first sample is a database of HWs who were examined by the German Occupational Physicians Network using an interferon-gamma release assay (IGRA). The second sample consists of general employees (non-health workers, non-HWs) from Hamburg who had no professional contact with the health care system. Propensity score matching (PS matching) was performed to ensure better comparability of the groups. The differences in the prevalence of positive test results from IGRAs were examined using univariate and multivariate analyses. After the PS matching of 1:10, 100 test subjects in the non-HW group and 1000 HWs remained to form the analysis collective. The HWs tended to exhibit higher IGRA values than non-HWs. The univariate analysis showed an odds ratio (OR) of 3.86 for the HWs (95% confidence interval (CI): 0.99 to 32.5; p = 0.056) with respect to a positive test result. The multivariate analysis produced an OR of 4.92, (95% CI: 1.3 to 43.7; p = 0.013) for HWs born in Germany. Despite the declining tuberculosis incidence rates in Germany, a comparison with non-exposed professional groups showed that HWs are at greater risk of LTBI. Preventive medical check-ups still seem to be indicated.<\/jats:p>","DOI":"10.3390\/ijerph17134643","type":"journal-article","created":{"date-parts":[[2020,6,29]],"date-time":"2020-06-29T05:28:56Z","timestamp":1593408536000},"page":"4643","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Risk Analysis of Latent Tuberculosis Infection among Health Workers Compared to Employees in Other Sectors"],"prefix":"10.3390","volume":"17","author":[{"given":"Lisa","family":"Hermes","sequence":"first","affiliation":[{"name":"Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan Felix","family":"Kersten","sequence":"additional","affiliation":[{"name":"Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Nienhaus","sequence":"additional","affiliation":[{"name":"Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"},{"name":"Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Schablon","sequence":"additional","affiliation":[{"name":"Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Peters, C., Kozak, A., Nienhaus, A., and Schablon, A. (2020). Risk of Occupational Latent Tuberculosis Infection among Health Personnel Measured by Interferon-Gamma Release Assays in Low Incidence Countries\u2014A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17020581"},{"key":"ref_2","first-page":"593","article-title":"Risk of tuberculosis infection and disease associated with work in health care settings","volume":"11","author":"Menzies","year":"2007","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"177","DOI":"10.7326\/0003-4819-149-3-200808050-00241","article-title":"Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: An update","volume":"149","author":"Pai","year":"2008","journal-title":"Ann. Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1136\/thx.2010.143180","article-title":"Interferon-gamma release assays for tuberculosis screening of healthcare workers: A systematic review","volume":"67","author":"Zwerling","year":"2012","journal-title":"Thorax"},{"key":"ref_5","first-page":"221","article-title":"Interferon-gamma release assays for the diagnosis of latent tuberculosis infection: An updated review","volume":"43","author":"Moon","year":"2013","journal-title":"Ann. Clin. Lab. Sci."},{"key":"ref_6","unstructured":"Brodhun, B., Altmann, D., Hauer, B., and Haas, W. (2019). Bericht zur Epidemiologie der Tuberkulose in Deutschland f\u00fcr 2018."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1159\/000086261","article-title":"Review of epidemiological studies on the occupational risk of tuberculosis in low-incidence areas","volume":"72","author":"Seidler","year":"2005","journal-title":"Respiration"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1586\/eri.12.150","article-title":"IFN-gamma release assay versus tuberculin skin test for monitoring TB infection in healthcare workers","volume":"11","author":"Nienhaus","year":"2013","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1745-6673-7-8","article-title":"Infectious diseases in healthcare workers\u2014An analysis of the standardised data set of a German compensation board","volume":"7","author":"Nienhaus","year":"2012","journal-title":"J. Occup. Med. Toxicol."},{"key":"ref_10","unstructured":"Jensen, P.A., Lambert, L.A., Iademarco, M.F., and Ridzon, R. (2005). Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings, 2005, NIH Pub."},{"key":"ref_11","unstructured":"Federal Ministry of Labour and Social Affairs (2020, June 26). Ordinanz for Preventive Occupational Medical Care (Verordnung zur Arbeitsmedizinischen Vorsorge\u2014ArbMedVV). Available online: https:\/\/www.bmas.de\/SharedDocs\/Downloads\/DE\/PDF-Publikationen\/a453-arbeitsmedizinischen-vorsorge.pdf?__blob=publicationFile."},{"key":"ref_12","unstructured":"Nienhaus, A., Brandenburg, S., and Teschler, H. (2017). TB-Vorsorge entsprechend der Verordnung zur arbeitsmedizinischen Vorsorge. Tuberkulose als Berufskrankheit. Ein Leitfaden zur Begutachtung und Vorsorge, Ecomed."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"ofx137","DOI":"10.1093\/ofid\/ofx137","article-title":"Risk of Tuberculosis Infection and Disease for Health Care Workers: An Updated Meta-Analysis","volume":"4","author":"Uden","year":"2017","journal-title":"Open Forum Infect. Dis."},{"key":"ref_14","unstructured":"Hermes, L. (2020). Untersuchung des Risikos des Vorliegens einer Latenten Tuberkuloseinfektion in der Allgemeinbev\u00f6lkerung. [Ph.D. Thesis]. Unpublished."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Schablon, A., Nienhaus, A., Ringshausen, F.C., Preisser, A.M., and Peters, C. (2014). Occupational screening for tuberculosis and the use of a borderline zone for interpretation of the IGRA in German healthcare workers. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0115322"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1055\/s-0030-1256439","article-title":"New recommendations for contact tracing in tuberculosis. German Central Committee against Tuberculosis","volume":"65","author":"Diel","year":"2011","journal-title":"Pneumologie"},{"key":"ref_17","unstructured":"Heinze, G., and Ploner, M. (2020, June 26). Logistf: Firth\u2019s Bias-Reduced Logistic Regression. Available online: https:\/\/CRAN.R-project.org\/package=logistf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias reduction of maximum likelihood estimates","volume":"80","author":"Firth","year":"1993","journal-title":"Biometrika"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ho, D.E., Imai, K., King, G., and Stuart, E.A. (2011). MatchIt: Nonparametric Preprocessing for Parametric Causal Inference. J. Stat. Softw., 42.","DOI":"10.18637\/jss.v042.i08"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1093\/ejcts\/ezy167","article-title":"Statistical primer: Propensity score matching and its alternatives","volume":"53","author":"Benedetto","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_21","first-page":"597","article-title":"Propensity Score: An Alternative Method of Analyzing Treatment Effects","volume":"113","author":"Kuss","year":"2016","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_22","unstructured":"(2020). R Core Team R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"90","DOI":"10.5144\/0256-4947.2018.90","article-title":"Screening of latent tuberculosis infection among health care workers working in Hajj pilgrimage area in Saudi Arabia, using interferon gamma release assay and tuberculin skin test","volume":"38","author":"Bukhary","year":"2018","journal-title":"Ann. Saudi Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/1745-6673-6-19","article-title":"Screening for tuberculosis and prediction of disease in Portuguese healthcare workers","volume":"6","author":"Silva","year":"2011","journal-title":"J. Occup. Med. Toxicol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"773","DOI":"10.2169\/internalmedicine.56.7533","article-title":"The Direct Comparison of Two Interferon-gamma Release Assays in the Tuberculosis Screening of Japanese Healthcare Workers","volume":"56","author":"Tanabe","year":"2017","journal-title":"Intern. Med."},{"key":"ref_26","first-page":"Doc05","article-title":"Serial testing with an interferon-\u03b3 release assay in German healthcare workers","volume":"5","author":"Schablon","year":"2010","journal-title":"GMS Krankenhhyg. Interdiszip."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1745-6673-7-6","article-title":"Interferon-gamma release assays for the tuberculosis serial testing of health care workers: A systematic review","volume":"7","author":"Ringshausen","year":"2012","journal-title":"J. Occup. Med. Toxicol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"488","DOI":"10.3201\/eid1703.100947","article-title":"Tuberculosis among health care workers","volume":"17","author":"Baussano","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.ijid.2018.05.004","article-title":"Prevalence of and risk factors associated with latent tuberculosis in Singapore: A cross-sectional survey","volume":"72","author":"Yap","year":"2018","journal-title":"Int. J. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1183\/09031936.00053809","article-title":"Tuberculosis screening in Portuguese healthcare workers using the tuberculin skin test and the interferon-gamma release assay","volume":"34","author":"Cardoso","year":"2009","journal-title":"Eur. Respir. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1801789","DOI":"10.1183\/13993003.01789-2018","article-title":"Latent tuberculosis infection in healthcare workers in low- and middle-income countries: An updated systematic review","volume":"53","author":"Apriani","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s15010-016-0963-2","article-title":"TB or not TB consortium Risk for latent and active tuberculosis in Germany","volume":"45","author":"Herzmann","year":"2017","journal-title":"Infection"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12995-016-0148-z","article-title":"QFT-Plus: A plus in variability?\u2014Evaluation of new generation IGRA in serial testing of students with a migration background in Germany","volume":"12","author":"Knierer","year":"2017","journal-title":"J. Occup. Med. Toxicol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12995-017-0159-4","article-title":"Prevalence of latent tuberculosis infection among foreign students in L\u00fcbeck, Germany tested with QuantiFERON-TB Gold In-Tube and QuantiFERON-TB Gold Plus","volume":"12","author":"Knierer","year":"2017","journal-title":"J. Occup. Med. Toxicol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/13\/4643\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:43:57Z","timestamp":1760175837000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/13\/4643"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,28]]},"references-count":34,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["ijerph17134643"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17134643","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,28]]}}}