P. McDowall, County Durham and Darlington NHS Foundation Trust, UK

Background:

Cases of Tuberculosis (TB) are declining in England, but multi-drug-resistance is increasing[1]. TB can present insidiously, be easily missed, poses a greater risk to those immunosuppressed[2], and requires contact tracing. Healthcare workers (HCWs) are an occupational group identified as at increased risk[3].

Case:

64 HCWs in North East England had occupational contact with extensively-drug-resistant TB (XDRTB). Outbreak Control Meetings (OCMs) with Public Health England were convened. The Occupational Health Service (OHS) was involved in contact tracing and arranging referral to TB services as required.

Discussion:

Important considerations included:

• Defining ‘close contact’: broadened to include those with 1 hour cumulative exposure
• Screening: no treatment available for latent XDRTB, but HCW being aware of status was important – decision made to offer screening to all contacts

Contact tracing was a balance between raising awareness, avoiding anxiety, and efficient use of OHS resources. A tiered approach was used:

• Written contact: warn and inform letters
• Review of OHS records to risk stratify contacts – e.g. immunosuppression
• Telephone contact: initially high risk contacts; then extended to all contacts
• GP contact: Health Protection Team sent letters to GPs requesting contac

Conclusions:

• Screening of OHS records facilitated identifying high risk contacts
• Individual risk assessments rather than ‘standard rules’ e.g. 8 hour ‘close contact’ were important
• Splitting OCMs into smaller sub-groups (e.g. HCW vs community contacts) made complex discussions more efficient
• Single OHS representative at OCMs improved efficiency
• Collaboration with HPT invaluable in contacting HCW’s GPs
• In future, in-person contacts in workplace may improve efficiency and engagement

References:

1. Tuberculosis in England, 2021 report (Presenting data to end 2020); UK Health Security Agency

Available from:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1030165/TB_annual-report-2021.pdf

2. British Thoracic Society recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-α treatment; Thorax 2005;60:800-805.

Available from:

https://thorax.bmj.com/content/60/10/800

3. Tuberculosis: the green book, chapter 32; UK Health Security Agency

Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/731848/_Greenbook_chapter_32_Tuberculosis_.pdf