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International Journal of Epidemiology 2001;30:1022-1028
© International Epidemiological Association 2001

Infectious Disease

Prevalence and determinants of tuberculin reactivity among physicians in Edmonton, Canada: 1996–1997

Sabrina S Plitta,b, Colin L Soskolnea, E Anne Fanningc and Stephen C Newmana,d

a Department of Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
b Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, Maryland, USA.
c Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
d Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Abstract

Background Health care workers (HCW) have historically borne a heavy burden of tuberculosis (TB) infection and disease. Unfortunately, physicians are rarely included in HCW surveys of tuberculin exposure and infection.

Methods The prevalence and risk factors for tuberculin reactivity were determined for a sample of the 1732 licensed physicians in Edmonton. Stratified random sampling was used to select 554 specialists and 219 general practitioners. These physicians were contacted by means of an introductory letter and a follow-up telephone call to solicit participation. All eligible physicians were asked to complete a questionnaire and those with either no recorded positive tuberculin test or a previously negative result were two-step tuberculin skin tested.

Results In total, 560 physicians (72.4 %) participated in the study. The overall tuberculin reactivity for this population was 45.9%. Using logistic regression analysis, we determined that risk factors for reactivity were aged over 45 years, of foreign-birth, previous Bacillus Calmette-Guérin (BCG) vaccination, foreign practice experience, and being a respiratory medicine specialist.

Conclusion The prevalence of tuberculin reactivity among physicians is considerably higher than estimates for the general Canadian population. This observed excess risk may be associated with factors linked to their medical practice. The high participation rate suggests physician willingness to participate in this type of research, and emphasizes the need to include them in routine HCW surveillance.

Keywords BCG, tuberculosis, health care workers, physicians, epidemiology, tuberculin skin tests

Accepted 16 August 2000


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