The devastation of the last two years of the Ebola crisis in West Africa was made all the more daunting by a predictable aspect of its toll. The health workers who represented the best hope of controlling the outbreak were also at the greatest risk of illness and death. By the dwindling days of the epidemic across Guinea, Sierra Leone and Liberia, at least 500 of the more than 11,300 people who had lost their lives to virus were health workers.
That illness is an occupational hazard on the front lines of health care is not new, a Clinical Infectious Diseases supplement on tuberculosis control in health settings notes, but it continues to be neglected at every level. And, as authors of one article note, while the death toll of the 2014-2015 Ebola outbreak is replicated by tuberculosis every three days worldwide, health workers in high burden and low-resource settings face risks at least three times those of the general population. They include doctors, nurses, counselors, administrative staff, lab technicians and medical students, and in settings across the world they are in short supply. Yet while responsibility for worker protections and infection control need to be shared by government policy, facility management and supervisory levels as well as individuals, one piece in the supplement notes, too often systemic approaches are neglected by an emphasis on personal protective equipment.
The supplement includes case histories:
- Of a South African medical student diagnosed with tuberculosis whose greatest worry was the setback to her studies, until she learned she had multidrug-resistant tuberculosis, which had killed one of her classmates;
- A physician being treated for multidrug resistant tuberculosis facing the choice of losing her life, or losing her career when she began to lose her hearing, a standard side effect of her treatment;
- Another physician diagnosed with extensively drug-resistant tuberculosis, a strain of disease resistant to at least two first line treatments and at least three second line treatments;
In fact, the case history piece notes, with authors that include the physician whose hearing was threatened, while health workers face triple the risks of getting sick with tuberculosis than others in their communities, in South Africa they are up to six times more likely to contract disease that is resistant to first line treatments.
Risks increase steeply with HIV infection, another article that explored Occupational Risk Factors for Tuberculosis Among Healthcare Workers in KwaZulu-Natal, South Africa shows. The authors of that study, led by Carrie Tudor of Johns Hopkins University School of Nursing, reviewed surveys of 145 workers in high tuberculosis settings and found HIV infection to be the greatest single risk factor for tuberculosis among respondents. The results call for improved infection control efforts that include adequate ventilation and stepped up identification, isolation, and care for patients with suspected or confirmed tuberculosis, as well as accelerated efforts to provide HIV testing and treatment to health workers.
Another piece the weight of stigma surrounding both HIV and TB among health workers, showing how it hinders access to onsite services.
The upshot, authors note, is that a pervasive, supported and committed approach is necessary if the global health threat of tuberculosis is to be ended, with resources that match the dangers the disease poses to those on the front lines.