OCCUPATIONALLY ACQUIRED TB - 2020 SALOSHNI NAIDOO
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OCCUPATIONALLY ACQUIRED TB
2020
SALOSHNI NAIDOO
naidoos71@ukzn.ac.za
UKZN INSPIRING GREATNESS
OUTLINE • Burden of illness in occupational settings • Legislation for workplace control and surveillance • General surveillance and disease specific for occupational TB • Management of a positive worker from the occupational perspective
BURDEN OF OCCUPATIONAL TUBERCULOSIS:SA Kootbodien T et al. Int J Environ Res Public Health. 2018;15(12):2756.l
BURDEN OF TB IN MINERS:SA
• PTB still a problem
despite decrease
by 17% in number
of reported cases
• Silico-tuberculosis
cases increased by
43%
Annual report DMR 2017/2018
BURDEN OF TB IN HCWS:SA
• Studies in the WC and
KZN
• Public sector hospitals
• Prevalence, Incidence
and Drug Resistance TB
far higher than the
general population and
local communities
OHS LEGISLATION: TB
• Occupational Health and Safety Act No 85 of 1993
• “Every employer shall provide and maintain, as far as is reasonably practicable, a working environment
that is safe and without risk to the health of his employees”
• “medical surveillance" means a planned programme or periodic examination (which may include clinical
examinations, biological monitoring or medical tests) of employees by an occupational health practitioner
or, in prescribed cases, by an occupational medicine practitioner”
• Mines Health and Safety Act No 29 of 1996
• “The employer of every mine that is being worked must ensure, as far as reasonably practicable, that the
mine is designed, constructed and equipped to provide conditions for safe operation and a healthy working
environment; “
• “The employer must establish and maintain a system of medical surveillance of employees exposed to
health hazards”
• Hazardous Biological Agents Regulations and Surveillance (Reg 22956; 2001)
• Regular Risk assessment every 2 years and records kept.
• Provision of information and training to employees on potential risks of HBA and risk reduction
• Medical surveillance based on risk assessment or presence of an Occupational disease directly related
to exposureSURVEILLANCE OF OCCUPATIONAL TB
RISK
ASSESSMENT
• CLINICAL ASSESSMENT &
MANAGEMENT
SURVEILLANCE • ADMINISTRATIVE & LEGAL
PROGRAMME MANAGEMENTRISK ASSESSMENT • Risk Assessment Team • Risk for TB transmission in the work place • Sources of exposure • Pathways for transmission • High risk worker groups • Informs medical surveillance • Identification and review of controls • Administrative • Engineering • PPE
MEDICAL SURVEILLANCE: GENERAL ON
EMPLOYMENT
• Health Evaluation
• Within 14 days of starting work
• Occupational history
• Physical examination
• Investigations guided by clinical findings and job exposure of worker
• Lung function tests
• Chest –x ray
• VCT
• Unfit worker shall not work in an exposed workplaceMEDICAL SURVEILLANCE: FOLLOW UP • Two yearly medical examination • self administered follow-up health questionnaire • clinical medical examination • employees presenting with signs or symptoms of underlying disease on follow-up questionnaire or clinical examination should be investigated further
WHO TO SCREEN FOR TB
• Those at increased risk of contracting TB
Workers in high risk settings
• Healthcare workers
• Miners
• Those at increased risk of progression from
LTBI ACTIVE TB
HIV-infected and immunocompromised due to other conditionsSCREENING FOR LTBI ? • Identify those at high risk of progression • Prevent active TB • Referral for optimal care and management i.e. TB infection and HIV (IPT) • Evaluate and monitor efficacy of infection control measures ??
SCREENING FOR ACTIVE TB ? • High Risk population • Early detection of active TB • Limit spread • Limit disability • Access to social security (compensation) • Referral for optimal care and management • Retention of scarce and skilled workforce??
SCREENING TESTS FOR LTBI • Tuberculin Skin Tests • Mantoux (PPD) • Intradermal • Past TB, Immunization, Past testing (booster), Immune compromise, Age • Immunoglobulin tests • QuantiFERON-TB Gold test (QFT-G) • T SPOT-TB • Measures the patient’s immune system reaction to M. tuberculosis • LTBI vs active TB NB: No evidence that IGRAs are superior to TST in High incidence countries .
TB SURVEILLANCE: HIGH RISK
• “Cough questionnaire”
• three monthly basis
• Routine recording of body mass
• monthly recording of body mass
• positive responses to questions on the respiratory questionnaire or
unexplained weight loss of 5 kilograms or more should be further investigatedCOUGH QUESTIONNAIRE • Do you have a cough that has lasted longer than three weeks? • Are you coughing at night? • Do you have a dry cough? • Do you cough up blood? • Have you lost your appetite? • Have you lost weight (more than 5 kilos) in the last two months without trying to? • Do you have night sweats (need to change the sheets or your clothes because they are wet)?
WHAT DO I DO IF I HAVE A WORKER WHO
TESTS POSITIVE?:TB
• Clinical Management
• Gene xpert , culture confirmatory
• Identify close contacts and screen
• Administrative
• Notifiable disease
• Compensation for TB
• Decision about time off work
• Clinical status
• Co-morbidity
• Leave
• Fitness assessment for return to workCOMPENSATION LEGISLATION: Workers
other than the mining setting
• Compensation for Occupational • Circular 178
Injuries and Diseases Act (COIDA) • Impairment
• Pulmonary impairment will be determined by
• CIRCULAR INSTRUCTIONS the lung function test done in accordance
• Pulmonary TB No 178 with the CC’s Circular instruction on
Respiratory Impairment.
• Amendment to Schedule 3 • Permanent disability
(covers disease acquired due to • The final medical report and lung function
occupational exposure to test must be submitted 12 months after
biological disease) completion of treatment of tuberculosis or
when the treating medical practitioner
considers no further improvement is
anticipatedCOMPENSATION PROCESS: TB • Employer’s report W.CL1 • First Medical report W.CL 22 (together with investigations and results) • Notice of an OD W.CL 14 • Lab reports of sputa results • Exposure history W.CL 110 • Medical report of treating doctor • Progress medical report W.CL 26 • Final medical report + Spirometry (TB) • Chest radiograph where applicable
COMPENSATION BENEFITS: TB (COIDA) • Temporary or partial disablement up to 24 months • Permanent disablement after final medical report is received • Medical aid up to 24 months from the date of diagnosis • Death benefits: includes reasonable burial expenses, widow’s and dependents pensions (proviso that claimant dies as a result of occupational disease) • 100% = 75% of salary • Future costs???
RETURN TO WORK: TB
• Clinical assessment of employee
• Determine fitness for duty
• Decide if the employee can
• Return to the original job
• Return with modification
• Alternate options
• Medical BoardingCOMPENSATION LEGISLATION: Mining • Occupational Diseases in Mines and Works Act No.78 of 1973 (ODMWA) • Compensation for Cardio-respiratory disease in miners (current and ex) • Compensable diseases • Pneumoconiosis • Silicosis, Asbestosis, Coal Workers pneumoconiosis • Tuberculosis • Pneumoconiosis & TB • COAD (also with TB) • Progressive Systemic Sclerosis • Mesothelioma • Platinum Salts Sensitivity (PSS)
COMPENSATION IN MINERS: ODMWA
• TB SPECIFIC DISEASE
• TB
• Current miners (more than 200 risk shifts = 9 months of work)
• Ex-miners within 12 months of leaving the mine
• Silico-tuberculosis
• Current and ex miners (irrespective of time period)
• COAD (with TB)
• PAYMENT BENEFITS
• Temporary incapacity for active TB – 75% of wages while on treatment
• Autopsy benefit
• No medical aid
• No pensionQUESTIONS
REFERENCES • Occupational Health and Safety Act (https://www.gov.za/documents/occupational- health-and-safety- act?gclid=CjwKCAjw74b7BRA_EiwAF8yHFF9W5Kta7XqWdOODncV4Ouqbetg1zyarr2lZ74v GiUG71JwrV6D0HBoCX1IQAvD_BwE) • Hazardous Biological Agents regulations (https://www.gov.za/documents/occupational- health-and-safety-act-regulations-hazardous-biological-agents) • Mines Health and Safety Act (https://www.mhsc.org.za/sites/default/files/public/publications/Mine%20Health%20and %20Safety%20Act%2029%20of%201996%20and%20Regulations%20Final%20Booklet.pdf) • COIDA (http://www.labour.gov.za/DocumentCenter/Publications/Compensation%20for%20Occu pational%20Injuries%20and%20Diseases/Notice%20on%20compensation%20for%20Occ upationally%20acuired%20corona%20virus%20under%20COIDA%20Amended%20Act.pdf ) • ODMWA (https://www.gov.za/documents/occupational-diseases-mines-and-works-act- 21-apr-2015-1257 )
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