TB Outbreak among Eastern European migrant workers in a salad factory in the West Midlands
PHE ePoster Library. Brehmer C. Apr 10, 2019; 257494; 15376
Clare Brehmer
Clare Brehmer
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Abstract Background:
In May 2018, Public Health England (PHE) investigated a tuberculosis (TB) outbreak in a salad factory after a migrant worker died from TB. Reports that the index case had been coughing since arrival in the UK suggested an infectious period of one year. During this time the case had worked in the fields and then in the factory, first living in a caravan on-site before moving to a house with other workers. Neither the recruiting agency nor the factory offered occupational health services.
: Household contact screening was conducted by the local TB service using interferon-gamma release assay (IGRA) testing. On the decision of the incident management team (IMT), PHE arranged on-site screening of co-workers on the shift team. This was subsequently extended to all factory workers due to the high LTBI rate. Information and results letters were translated into ten languages and members of the PH team provided Q&A sessions for the workers. Those with positive IGRA results were referred to local TB services based on residential address.
: Household contact screening identified another active TB case working in the same shift team. Whole genome sequencing revealed that the strains were indistinguishable (0 SNPs) and previously unrecorded in the UK. Screening of the single shift team revealed an LTBI rate of 34%. 331 factory workers (including 90 agency staff) were offered screening, with 78% uptake. Total LTBI prevalence was 28%.77 were referred to local TB services. A further 271 ex-employees were identified as potentially exposed and sent letters recommending TB testing.
LTBI prevalence among the factory workers was far higher than prevalence in the migrants' home countries, suggesting a reverse Healthy Worker Effect. This investigation highlights the gap in occupational health services for migrant workers and the consequences of factory-based TB transmission on the wider health economy.
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