台灣健康照護工作人員罹患結核病之流行病學調查研究

An Epidemiological Study of Tuberculosis among Health Care Workers in Taiwan

歐美高所得國家之健康照護工作人員感染結核菌的年危險性為0.1%-1.2%，為瞭解台灣健康照護工作人員罹患結核病現況，以民國91年1月4日至民國95年12月31日，疾病管制局結核病資料庫中職業為健康照護工作人員做為研究對象，進行分析。結果發現，民國91年至95年我國健康照護工作人員罹患結核病的人數共計564人，其中男性109人、女性455人，每年人數由民國91年的63人增加至民國95年的149人。在縣市分佈上以台北市個案最多。73%的個案年齡在40歲以下。其中開放性肺結核個案共計204人。胸部X光檢查、痰塗片及痰培養等三種診斷方法，平均完成率分別為90.4%、88.1%、71.1%。另以民國95年台北區6縣市共49名健康照護工作人員罹患結核病之疫情調查資料做進一步分析，其中以護理人員及醫師為主，分別佔59.2%及22.5%；而個案之工作單位分佈於各部門，其中以一般病房佔較高比例（28.6%）。若以台北區所有護理人員及醫師總人數換算，護理人員及醫師罹患結核病之發生率分別為80.7/100,000 及86.0/100,000人。本研究結果顯示，罹患結核病之健康照護工作人員主要發生在年齡39歲（含）以下的個案，顯著低於一般國人，可能與第一線健康照護工作人員年齡較輕有關。另一般國人罹患結核病的男女比率為2 : 1，與本研究結果顯著不同，可能因護理人員人數眾多且其工作性質大都屬第一線。而醫護人員罹患結核病的發生率高於一般人，顯示如何防範健康照護工作人員罹患結核病仍然是本國一個重要的課題。（感控雜誌2008; 18: 69-80）。

The annual risk of tuberculosis (TB) infection in health care workers in western high-income counties is 0.1-1.2%. In order to estimate the TB incidence in health care workers in Taiwan, the relevant diagnostic data from the Taiwan CDC database from January 1, 2002 to December 31, 2006 were analyzed. A total of 564 subjects (109 males and 455 females) were enrolled, with the annual number of cases increasing from 63 in 2002 to 149 in 2006, and 73% of them were under 40 years of age. By geographic distribution, there was the largest number of cases in Taipei City. Of the 564 subjects, 204 were open TB cases. The average rates of subjects received the chest radiography, and sputum smear and culture were 90.4%, 88.1% and 71.1%, respectively. Further analysis was performed for the 49 TB cases diagnosed in Taipei region in 2006. The majority of these individuals were nurses or physicians (59.2% and 22.5%, respectively). Their working places varied widely, with many cases worked in the general wards (28.6%). The incidence rates of tuberculosis in nurses and physicians were 80.7 and 86.0 per 100,000 in Taipei region. Our results show that, in Taiwan, TB occured in health care workers mostly under the age of 40 years, which is obviously younger than TB cases in general population. This might be due to the juniority of first-line health care workers, such as nurses. Furthermore, the male-to-female ratio of TB cases in general population in Taiwan is 2:1, which differs significantly from the gender distribution of TB cases in health care workers found in this study. This probably is due to the fact that most of the health care workers providing first-line primary care in Taiwan are female nurses. The incidence of TB in health care workers is higher compared to the general population. Thus, prevention of TB infection in these professionals remains an important issue in Taiwan.(Infect Control J 2008;18:69-80).