Review of epidemiological studies on the occupational risk of tuberculosis in low-incidence areas

This review summarizes the epidemiological evidence for occupationally acquired tuberculosis and considers the implications for the prevention of tuberculosis. The relevant epidemiological studies were identified on the basis of the Medline data bank, starting with the year 1966. The evaluation of occupational groups with an elevated tuberculosis risk is exclusively based on epidemiologic studies of good or acceptable quality, applying clearly defined criteria of methodological quality. In summary, the available epidemiological evidence suggests that the risk of tuberculosis is elevated in the following occupational groups: hospital employees in wards with tuberculosis patients; nurses in hospitals; nurses attending HIV-positive or drug-addicted patients; pathology and laboratory workers; respiratory therapists and physiotherapists; physicians in internal medicine, anaesthesia, surgery and psychiatry; non-medical hospital personnel in housekeeping and transport work; funeral home employees, and prison employees. However, the epidemiological evidence is limited for all these occupations, with the exception of the nurses, because of the lack of methodologically adequate studies that have got the statistical power to differentiate between specific work tasks. There is a need for large population-based studies with precise definition of exposure, which should include molecular epidemiologic methods in the investigation of occupational risk factors of tuberculosis.