Prevalence and Factors Associated with Tuberculosis Among Healthcare Workers: A Systematic Review with Meta-Analysis

Abstract

Background: Healthcare workers are exposed to an unhealthy environment that increases the risk of developing tuberculosis. Objective: To analyze the prevalence and factors associated with tuberculosis among healthcare workers. Methods: A systematic review with meta-analysis was conducted using six databases. Methodological quality was assessed according to JBI recommendations. A random-effects meta-analysis was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed for reporting. Results: Thirty-two articles were included in the evidence synthesis. The prevalence of tuberculosis among healthcare workers was found to be 15.92% [95% CI 8.49–27.88|I² = 99% | p = 0]. Female sex was associated with 1.37 times higher odds of infection [95% CI 0.68–2.38, I² = 80%, p = 0.01]. Advanced age increased the odds by 1.47 times [95% CI 1.33–4.62, I² = 76%, p = 0.01]. Conclusions: Early diagnosis of tuberculosis in the workplace and the implementation of continuing education programs with preventive strategies are essential to control contamination and the spread of the disease: CRD42022320153.

1. Introduction

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis and is considered one of the main communicable diseases of global public health concern [1,2]. Early detection and control of TB represent a challenge for health services, especially for low-income countries with high levels of social inequality [3].

Brazil is on the list of 30 countries with a high TB burden, accounting for 87% of all TB cases worldwide [4]. TB also results in 1.5 million deaths annually and is classified as the second leading cause of death from a single infectious agent, second only to COVID-19. The disease is also the ninth leading cause of death globally [5,6]. The global annual incidence of TB is estimated at 142 cases per 100,000 inhabitants [6]. In Brazil, 84,308 cases were reported in 2024, resulting in 39.7 cases per 100,000 inhabitants [7]. TB often affects vulnerable groups [8], including healthcare workers, whether in primary care, outpatient, or hospital settings [9,10]. These professionals are exposed to aerosols produced by infected patients during coughing or sneezing while providing care [2,9,11]. It is estimated that healthcare workers are 1.9 to 5.7 times more likely to develop TB compared to the general population. This risk increases according to the TB burden in the country and the levels of infection control measures [12]. This reality makes the disease an important occupational problem of global concern [2].

To address this challenge and provide a safer working environment for healthcare workers, the World Health Organization (WHO) established the “End TB” Strategy in 2015, which aims to reduce the incidence of TB by 95% by 2030. To achieve this goal, infection control in healthcare settings was included as a priority component [13]. In Brazil, the Ministry of Health (MoH), in 2014, included in the Notifiable Diseases Information System (SINAN) a field referring to specific populations in which there is a category for healthcare workers, allowing the monitoring of cases in this population [9].

According to the Ministry of Health, in 2024, 1284 cases of TB were reported among health workers in Brazil [7]. However, it is important to highlight that these professionals can be infected with M. tuberculosis and not develop the disease, as the bacillus can remain in a latent state for decades. This condition is called Latent Tuberculosis Infection (LTBI), and its prevalence exceeds 30% among healthcare workers. Furthermore, the risk of illness in this group is nearly three times higher than in the general population [14].

Systematic reviews have been conducted on the subject [15,16,17], most of which present an analysis of prevalence in the general population but do not distinguish among healthcare workers. As mentioned, healthcare workers are considered a risk group for TB, as they are often in direct contact with large loads of the bacillus, depending on their area of work. Healthcare workers in countries with high TB prevalence are particularly at increased risk of TB infection and disease development due to their frequent, prolonged, and close exposure to infectious TB cases [18].

Therefore, this study becomes relevant because it aims to understand the prevalence of active disease in this specific population, as well as its related factors, aiming to minimize the knowledge gap still present in the current literature. It is, therefore, essential to carry out a systematic review that updates the evidence on the subject, allowing a critical reflection on the occurrence of TB among health service workers, especially considering the cascade of care. This study aims to analyze the prevalence and factors associated with tuberculosis among healthcare workers.

2. Materials and Methods

2.1. Protocol and Registration

This is a systematic literature review with meta-analysis [19], conducted according to the recommendations and criteria of the Joanna Briggs Institute (JBI) [20] and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [21]. The protocol for this review was registered on York University’s International Prospective Register of Systematic Review (PROSPERO) platform under number CRD42022320153 on 27 April 2022.

2.2. Research Question and Eligibility Criteria

The research question was as follows: What is the prevalence and the factors associated with tuberculosis among healthcare workers? The acronym CoCoPop (Condition, Context, and Population) was used [20]. The chosen condition was TB, the context considered was healthcare settings, and the population was healthcare workers.

The inclusion criteria were studies involving healthcare workers (with technical or higher education level) working in healthcare settings, regardless of the level of care, who developed tuberculosis.

The inclusion criteria were studies involving healthcare workers (with technical or higher education level) working in healthcare settings, regardless of the level of care, who developed TB. This review included studies that described cases of tuberculosis with a confirmed clinical and/or laboratory diagnosis, through sputum smear microscopy, culture, rapid molecular testing, or official notification system records, in accordance with the criteria established by health authorities. Studies that presented partial results and/or did not directly address the research question were excluded, as well as those that investigated associations between TB and other health conditions, and those for which it was not possible to access the full data after three attempts to contact the authors by e-mail. It is worth noting that there were no restrictions regarding time period or language.

2.3. Data Source Search

The database search took place in December 2023, covering the following databases: SCOPUS (Elsevier), Web of Science (WoS), MEDLINE (PubMed), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and LILACS (Latin American and Caribbean Health Sciences Literature).

2.4. Search Strategy

The search strategy was developed using Medical Subject Headings (MeSH) to identify relevant studies in literature. The main search terms included “Tuberculosis”, “Health Care Workers”, and “Health Services”. Boolean operators “AND” and “OR” were applied to appropriately combine the terms, enhancing both the sensitivity and specificity of the search. Detailed search strategies for each database are provided in Table S1.

2.5. Study Selection Process

After screening the articles in the databases, the studies were imported into the literature citation manager Start of the Art through Systematic Review. Subsequently, the references of all the selected studies were searched to identify additional relevant studies. The studies were selected independently and blindly by two reviewers/authors, both with experience in systematic review and the study area. A first reading of titles and abstracts was conducted, with the selected materials being fully reviewed later. Consensus meetings were held regarding the inclusion of articles, and any disagreements were discussed with the participation of a third reviewer/author of the study.

2.6. Data Extraction, Processing, and Analysis Process

The results were synthesized in a Microsoft Excel^® spreadsheet, taking into account the following variables for extraction: study characteristics (author, year, title, journal, country of origin), methodological aspects (study type, level of care, professionals, and sample), and prevalence results and factors associated with tuberculosis, as well as objectives, main findings, and conclusions.

2.7. Evaluation of Methodological Quality

The eligible studies underwent a methodological quality assessment, using the JBI recommendations, by two independent reviewers/authors. In cases of disagreement, the opinion of a third reviewer/author was requested. On a scale consisting of nine criteria, the studies were classified as follows: zero to three criteria (low quality), four to six criteria (medium quality), and seven or more (high quality) [22].

Subsequently, all the articles, regardless of their methodological quality, were subjected to data extraction and narrative synthesis.

2.8. Meta-Analysis

To assess the prevalence of TB among health professionals, random effects models were used to present the prevalence as a percentage, together with 95% confidence intervals. Heterogeneity between studies was assessed using the I² test, in which values above 50% and p-values less than 0.05 indicate high heterogeneity [23].

For a study to be included in the meta-analysis, it had to provide both the number of workers with TB and the total sample size. In cases where the studies only provided prevalence data, they studied the sample size. The years of data collection for each study were considered to analyze the trend in TB prevalence [24]. Subgroup analyses were conducted considering age, sex, education level, and years of service. The analysis was performed using the R program, with the Meta package.

3. Results

3.1. Descriptive Characteristics and Quality of Included Studies

Using the search strategies, 7392 articles were initially identified, 706 of which were duplicates; 146 records were marked as ineligible by automation tools and 72 records were removed for other reasons, leaving 6468 for screening. Next, 5589 articles that did not meet the inclusion criteria were excluded, including 879 full-text studies. After reading all the articles, 32 were included in the review, as shown in Figure 1.

In assessing the methodological quality of the 26 studies included in this review, 21 (65.6%) achieved scores between seven and nine, indicating high methodological quality. Of these, eight studies attained the maximum score of nine, fully meeting all assessed criteria and demonstrating methodological rigor. Detailed results are presented in

Table 1. Critical assessment of methodological quality JBI. Rio Grande do Sul, Brazil, 2025.

ID	Author (Date)	1.	2.	3.	4.	5.	6.	7.	8.	9.	Final Score
78	Main et al., 2023	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	9
570	Leo et al., 2023	(+)	(+)	(+)	(+)	(+)	(+)	(I)	(I)	(+)	7
6321	Islam et al., 2023	(+)	(+)	(+)	(−)	(−)	(+)	(I)	(−)	(+)	5
6323	Alshahrani et al., 2023	(+)	(−)	(+)	(−)	(+)	(+)	(+)	(−)	(+)	6
6298	Apriani et al., 2022	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	9
1372	Phyu et al., 2020	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(I)	8
1376	Casas et al., 2020	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	9
1417	Erawat; Andriany, 2020	(+)	(+)	(+)	(−)	(+)	(+)	(+)	(−)	(+)	7
1448	Janagond et al., 2017	(+)	(+)	(+)	(−)	(I)	(+)	(+)	(+)	(+)	7
1455	Anwar et al., 2019	(+)	(+)	(+)	(−)	(+)	(+)	(+)	(+)	(+)	8
1490	Zakeya et al., 2018	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	9
2020	Costa et al., 2011	(+)	(+)	(+)	(−)	(+)	(+)	(+)	(+)	(+)	8
2234	Casas et al., 2013	(+)	(−)	(I)	(−)	(I)	(+)	(I)	(+)	(+)	4
2491	Lee et al., 2021	(+)	(+)	(+)	(−)	(+)	(+)	(+)	(+)	(+)	8
3784	Chaiear et al., 2016	(+)	(−)	(+)	(−)	(I)	(−)	(−)	(−)	(+)	3
4075	Wei et al., 2013	(+)	(+)	(+)	(I)	(+)	(+)	(+)	(−)	(+)	7
4225	Nienhaus et al., 2011.	(+)	(−)	(+)	(−)	(I)	(+)	(I)	(+)	(+)	5
4271	Park et al., 2010	(+)	(+)	(+)	(I)	(+)	(+)	(+)	(−)	(+)	8
4336	Yoshiyama et al., 2009	(+)	(+)	(+)	(−)	(+)	(+)	(+)	(+)	(+)	8
5481	Weddle et al., 2014	(+)	(+)	(+)	(−)	(+)	(+)	(+)	(−)	(+)	7
5503	Burrill et al., 1985	(+)	(+)	(+)	(−)	(+)	(+)	(+)	(−)	(+)	7
6145	Almohaya et al., 2020	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	(+)	9
5839	Tanabe et al., 2017	(+)	(I)	(+)	(−)	(+)	(+)	(+)	(+)	(+)	7
6330	Shey et al., 2023	(I)	(I)	(I)	(−)	(−)	(+)	(+)	(−)	(+)	3
6337	Rudeeaneksin et al., 2023	(I)	(I)	(I)	(−)	(−)	(+)	(+)	(+)	(+)	4
6436	Hernández et al., 2014	(I)	(−)	(−)	(−)	(−)	(+)	(+)	(+)	(I)	3

Source: Prepared by the authors, adapted from JBI [22]. Note: (−) did not meet this criterion; (+) met this criterion; (I) uncertain/not clear. The score ranges from 0 to 9, with higher scores indicating better study quality. 1. Is the sampling frame appropriate to address the target population? 2. Were study participants sampled appropriately? 3. Was the sample size adequate? 4. Were the participants and study design described in detail? 5. Was data analysis performed with sufficient sample coverage? 6. Were valid methods used to identify the condition? 7. Was condition measured in a standardized and reliable manner? 8. Was there appropriate statistical analysis? 9. Was the response rate adequate, and if not, was the low response rate managed correctly?

.

Among the studies included in this review, most were published in 2023 (n = 6), with the earliest dating back to 1985. The investigations were conducted in various countries, including Germany, Saudi Arabia, South Korea, Spain, India, Portugal, and Japan, and were published in international journals. In total, the studies analyzed data from 61,396 healthcare workers (mean = 4547.85; range = 76–61,396), of whom 3735 were diagnosed with tuberculosis (mean = 276.67; range = 5–3735), as detailed in

Table 2. Summary of the characteristics of the included studies. Rio Grande do Sul, Brazil, 2025.

Location	Population/Cases	Prevalence (95% CI)	Main Risk Factors Identified	JBI
Indonesia	792/60	7.58 (5.83–9.64)	Male sex, older age, and working in hospital settings.	9
India	1001/5	0.50 (0.16–1.16)	Male sex, advanced age, alcohol use, and exposure to TB patients in the workplace and household.	7
Bangladesh	1016/296	29.13 (26.35–32.03)	Male or female sex, older age, alcohol use, exposure to TB cases at work or in the household, and 11–20 years of service in healthcare.	5
Saudi Arabia	561/66	11.76 (9.09–14.43)	Male sex, older age, and length of employment.	6
Thailand	445/42	9.44 (6.89–12.03)	Tobacco uses disorder and having 10 or more years of work experience.	9
Asia	498/116	23.29 (19.65–27.26)	Education level below higher education, 10 or more years of service, insufficient knowledge about regular TB screening, and teaching cough etiquette to TB patients.	8
Spain	255/112	43.92 (37.74–50.25)	BCG vaccination status and the degree of occupational exposure to TB.	8
Indonesia	200/46	23.00 (17.36–29.46)	Having diabetes mellitus and hepatitis were comorbidities associated with greater exposure to TB, as well as educational level (being a midwife).	7
India	321/76	23.68 (19.13–28.71)	Occupational exposure to people with TB, absence of control measures, age, years of service, education level, and working in wards and intensive care units.	7
Egypt	188/53	28.19 (21.89–35.20)	Having 10 or more years of professional experience, a history of BCG vaccination, being diabetic, and being active smokers.	8
Saudi Arabia	520/56	10.77 (8.24–13.76)	The average age (34.9 years), length of service (13.1 years), and being a physician.	9
Portugal	2889/859	29.73 (28.07–31.44)	Age equal to or greater than 50 years and the number of years working in healthcare services.	8
Spain	1597/145	9.09 (7.72–10.60)	Being female, having an average age of 31 years, and working in healthcare services during the period from 1990 to 1995.	4
South Korea	3000/145	4.83 (4.09–5.66)	Advanced age, male sex, healed tuberculosis lesions on chest X-ray, and working in high-risk TB departments.	8
Thailand	173/60	34.68 (27.62–42.26)	Advanced age, male sex, longer duration of employment, presence of BCG scars, family history of TB, and TB in the past year.	3
China	210/161	76.67 (70.35–82.21)	Age over 30 years, working in a chest hospital for more than five years, and being a nurse.	7
Germany	1627/409	25.15 (23.05–27.32)	Age over 55 years, family history of tuberculosis, migration from a country with high TB incidence, prolonged contact (>40 h) with a sputum-positive index case.	5
South Korea	322/83	25.78 (21.09–30.92)	Newly hired healthcare workers.	8
Japan	425/5	1.18 (0.38–2.72)	Working in TB isolation wards.	8
United States	758/47	6.20 (4.59–8.16)	Travel to a country with high TB endemicity and having been vaccinated with BCG.	7
Canada	40664/57	0.14 (0.11–0.18)	Female sex and not being vaccinated with BCG	7
Saudi Arabia	3024/733	24.24 (22.72–25.81)	Age equal to or greater than 50 years, working as nurses and radiology technicians, and working in the emergency department or intensive care unit.	9
Chile	76/20	26.32 (16.87–37.68)	Older age	3
Japan	654/33	5.05 (3.50–7.01)	Having a previous chest X-ray and/or IGRA abnormalities, a history of TB treatment, comorbidities associated with immunodeficiency, and a history of TB exposure.	9
South Africa	78/33	42.31 (31.19–54.02)	Prolonged exposure of workers to the work environment.	3
Thailand	102/15	14.71 (8.47–23.09)	Healthcare professional	4

.

Table 2 shows the main risk factors for developing tuberculosis among healthcare workers. These factors include having an educational level below higher education, working for more than ten years in the field, lack of BCG vaccination, occupational exposure to tuberculosis, female sex, age over 50, smoking, and having comorbidities such as diabetes mellitus and hepatitis. The pulmonary form of tuberculosis was the most common among reported cases.

Furthermore, the high prevalence of LTBI among these professionals highlights the importance of preventive measures. Studies indicate that actions such as pre-employment screening, especially for those working in high-incidence areas, annual testing, regular infection control training, frequent use of hand sanitizers, and the use of N95 masks as personal protective equipment are essential. It is also crucial to maintain ongoing surveillance programs and adopt stricter preventive strategies to avoid tuberculosis transmission in the workplace. Additional findings from the studies included in this review are provided in the Supplementary Material (Table S2).

3.2. Prevalence of Tuberculosis Among Healthcare Workers

The analysis included 23 studies and revealed substantial heterogeneity, with an I² value of 99% (χ² = 2535.0, p = 0). The meta-analysis estimated an active tuberculosis prevalence of 15.92% (95% CI: 8.49–27.88) among a total population of 61,591 healthcare workers across all studies (Figure 2).

A meta-análise dos fatores associados revelou que o sexo feminino esteve associado a uma chance 1.37 vezes maior de infecção [IC 95%: 0.90–2.09; I² = 183%; p = 0.01] (Figure 3A). Quanto maior a idade do profissional, maior a probabilidade de desenvolver TB, com uma razão de chances de 1.08 [IC 95%: 1.02–1.15; I² = 57%; p = 0.05] (Figure 3B). Ser graduado aumentou as chances em 1.57 [IC 95%: 1.01–2.43; I² = 0%; p = 0.49] (Figure 3C), e ter dez ou mais anos de experiência profissional elevou as chances em 1.47 [IC 95%: 1.19–1.82; I² = 88%; p = 0.01] (Figure 3D).

As shown in

Table 3. Tuberculosis incidence by country. Rio Grande do Sul, Brazil, 2025.

Country	Incidence (/100,000 pop.)	95% Confidence Interval	Region
Myanmar	558	328–824	Asia
South Africa	427	265–626	Africa
Indonesia	387	354–432	Southeast Asia
Bangladesh	221	161–291	South Asia
India	195	164–228	South Asia
Thailand	157	114–214	Southeast Asia
China	52	44–61	Asia
South Korea	38	35–61	Asia
Chile	18	16–21	South America
Portugal	16	13–18	Europe
Japan	9.3	8–11	Asia
Egypt	9.2	7.8–11	Africa
Saudi Arabia	8.4	7.6–9.3	Middle East
Spain	5.9	5–6.8	Europe
Canada	5.8	5–6.7	North America
Germany	4.8	4.4–5.3	Europe
United States of America	3.1	2.6–3.6	North America

Source: World Health Organization (2023).

, the data indicate significant geographic variation in TB incidence. The highest rates were observed in Myanmar (558/100,000; 95% CI: 328–824), South Africa (427/100,000; 95% CI: 265–626), and Indonesia (387/100,000; 95% CI: 354–432), indicating a high TB burden, particularly in parts of Asia and Africa. In contrast, countries in Europe and North America reported significantly lower incidence rates, which are below the global average, reflecting the effectiveness of TB control programs in high-income settings.

4. Discussion

This review synthesized data on the prevalence and associated factors of TB among healthcare workers. The meta-analysis estimated a pooled prevalence of 15.92% (95% CI: 8.49–27.88) in this population. TB remains a serious public health concern within healthcare settings, directly impacting workers due to their occupational exposure. Although this issue was long neglected or underestimated by healthcare administrators and government representatives, healthcare workers are now increasingly recognized as a priority population in global TB control strategies due to their heightened vulnerability and critical role in disease elimination efforts [9,18,25,26].

The scarcity of studies addressing this issue globally underscores the need to strengthen scientific discourse and develop targeted public policies and programs focused on workers’ health. These findings align with recommendations from the WHO [13] and the Brazilian Ministry of Health [9], which recognize healthcare workers as a high-risk group due to their frequent direct or indirect contact with Mycobacterium tuberculosis during patient care activities [27,28]. Professional categories such as nursing, medicine, and physiotherapy are particularly exposed given the nature of their duties [29].

TB transmission occurs through inhalation of aerosols generated when an infected individual coughs, speaks, or sneezes. The bacilli can remain airborne for variable periods depending on environmental factors like ventilation and sunlight exposure [30]. Mycobacterium tuberculosis is highly contagious and poses significant health risks to workers. The often-delayed appearance of respiratory symptoms complicates early detection and preventive interventions [29,30,31].

Effective prevention of TB transmission within healthcare settings heavily depends on the implementation of management-led measures, including ongoing education and proper use of personal protective equipment (PPE) [26]. PPE is vital to shield healthcare professionals from infectious aerosols, droplets, and contaminated bodily fluids or surfaces, and its correct and consistent use significantly reduces transmission risk [32]. However, a study in Nepal found widespread insufficient knowledge and poor TB preventive practices among nurses, with none reporting use of N95 masks or respirators when caring for TB patients [33].

These findings highlight healthcare workers’ vulnerability to TB infection. Many countries’ labor regulations recognize TB as an occupational disease. In Brazil, TB is officially classified as an occupational illness and must be reported to the Notifiable Diseases Information System (SINAN) [34].

Comprehensive strategies and preventive measures are essential to reduce TB infection among healthcare workers. The WHO recommends tuberculosis preventive treatment (TPT) for individuals at increased risk, including healthcare workers, and advocates for a programmatic approach involving risk identification, screening, latent infection testing, regimen selection, adverse event monitoring, adherence support, and program evaluation [35,36].

In Brazil, the National Tuberculosis Control Policy prioritizes healthcare workers, complemented by the National Plan to End Tuberculosis as a Public Health Problem (2021–2030), which targets prevention, early diagnosis, and treatment in vulnerable groups [35]. The National Policy on Workers’ Health (PNSTT) further mandates occupational health surveillance, including mandatory TB notification linked to workplace exposure, and stresses institutional responsibility for infection control, PPE provision, and periodic screening [37].

These policies demonstrate Brazil’s progress in integrating international TB control guidelines into national public health frameworks. However, their success hinges on effective implementation throughout the health system and ensuring safe working conditions for all healthcare professionals.

Regarding occupational risk variations, the literature indicates TB infection rates among health workers are 3 to 20 times higher for nursing staff, 6 to 11 times higher for clinical pathologists, 4 to 8 times higher for healthcare students (nursing, physiotherapy, medicine), and 2 to 9 times higher for bacteriology laboratory technicians compared to the general population [35].

A study of nurses in China found that the prevalence of TB among nurses working in TB-related departments is 5.1 times higher than in the general population, and the incidence of LTBI among healthcare workers is between 17 and 36% [27]. In a study of 1870 healthcare workers in South Korea, 12% (229) tested positive for TB, and those of advanced age were 0.96 times more likely to develop the disease [33]. In a cross-sectional study assessing the burden of LTBI among health workers in Afghanistan, with 4648 health workers, the prevalence of latent TB infection was 47.2% (1738 workers) [38]. In Germany, the prevalence of LTBI is estimated at 10% based on examinations carried out in connection with the country’s occupational and preventive medicine [39].

Authors have found that nursing staff in hospitals are the most at risk of contracting TB. In addition, the disease is highly prevalent among other professional categories, such as healthcare assistants and maintenance workers, radiology technicians, pharmacists, physiotherapists, nutritionists, and medical students [28].

Health workers, in addition to being at increased risk of developing TB due to their working environment, as already noted, are also at risk of developing drug-resistant TB compared to the general population [40].

However, when analyzing Brazilian studies on TB in health workers, there is a gap in knowledge, in other words, invisibility [41]. Furthermore, controlling TB effectively is a matter of extreme concern since the lack of research in a given area of knowledge makes this population invisible to public health policies, leading to negative consequences for workers’ health and a lack of health coverage and prevention.

In order to achieve the ambitious targets set by the WHO through the End TB by 2035 strategy, countries need to incorporate innovation, investment, and the authority of effective public policies that reach vulnerable populations, including health workers [9,10,11,12,13]. The burden of TB on healthcare workers is a negative labor-related factor and, due to its nosocomial transmission, can make it difficult to achieve the goals of eliminating and eradicating TB since healthcare workers act as a reservoir of the bacillus, thus contributing to maintaining the cycle of transmission of the disease in society [28].

The transmission of TB in health services to workers is related to non-existent or inadequate infection control measures, especially in places with few material and physical resources [28,29,30,31]. This risk is proportionally more alarming in low- and middle-income countries due to increased exposure and the lack of preventive measures, such as poor ventilation in the workplace and inadequate precautions during sputum collection and bronchoscopy [38].

Other occupational risk factors associated with LTBI include being a nurse, a diabetic, a smoker, being over 35 years old, working in cleaning services, hospitalization units with high patient turnover, assisting people living with HIV, not having been vaccinated with Bacille Calmette–Guérin or being immunocompromised [37].

Thus, investment in research, policies and programs aimed at this high-priority population must be implemented and incorporated, especially in countries that have a high burden of circulating TB. In addition, by incorporating measures in health services to protect against ILTB through TB Preventive Therapy (TPT), with the implementation of this measure in health services, there is a potential reduction in the risk of progression of the disease by up to 90%; TPT aims to eliminate bacteria during their dormant state, thus maintaining a low rate of progression of the bacillus in the work environment, which consequently reduces transmission among health workers [38].

To reduce the rate of contamination among healthcare workers, it is recommended to implement screening and treatment of ILTB to prevent TB development among workers and transmission to other individuals [42]. Furthermore, a systematic review [43] highlighted the need to standardize methods for researching TB recurrence, promote actively seeking prevention of drug resistance, facilitate treatment retention and provide integrated care for patients with HIV that can reduce recurrence rates. Some countries, such as China, include in their institutional policies annual screening for ILTB among workers at high risk of exposure, as well as treatment [36].

Therefore, to implement effective measures that reduce the risk of bacillus contamination in occupational settings, it is essential that managers identify risk factors and develop strategies to minimize, reduce, or eliminate the likelihood of TB transmission in the workplace.

Notably, studies have identified weaknesses in the implementation of infection control measures in healthcare services. Many professionals believe that the use of personal protective equipment alone is sufficient for individual and collective protection, reflecting a limited understanding of the broader scope of biosafety practices—particularly the importance of screening measures [41].

Health institutions should implement regular screening programs to detect and monitor TB among healthcare workers, alongside effective administrative, environmental, and personal protective strategies to prevent transmission. These actions are essential for achieving the targets established by the WHO [33].

Mapping the epidemiological profile of TB across countries is a crucial step toward meeting global disease control goals. It enables targeted interventions in high-priority regions, offering greater protection to healthcare professionals at increased risk of exposure. Recent data reveal alarmingly high TB incidence rates in countries such as Myanmar (558/100,000; 95% CI: 328–824), South Africa (427/100,000; 95% CI: 265–626), and Indonesia (387/100,000; 95% CI: 354–432), all located in Asia and Africa. These findings emphasize the disproportionate burden of TB in low- and middle-income countries, which continue to face substantial public health challenges [44,45].

The 30 high-burden countries identified by the WHO’s End TB Strategy account for most global TB cases. These countries struggle with persistent barriers to disease control, and healthcare workers—positioned at the frontline—remain particularly vulnerable to infection [28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46].

Major obstacles include limited access to healthcare services, inadequate infrastructure, high socioeconomic burden, TB/HIV coinfection, drug resistance, weak infection control, and insufficient training for healthcare professionals [46,47,48]. Countries like Myanmar, South Africa, and Indonesia clearly illustrate these challenges. For instance, Myanmar contends with a triple burden: drug-susceptible TB, multidrug-resistant TB, and TB/HIV coinfection [49]. Sub-Saharan Africa and parts of Asia remain the most affected regions. In 2021, South Africa was among the countries with the highest global TB burden, underscoring the need for urgent, effective, and sustained interventions, especially given that TB is a curable disease with established policies and treatment options [50].

To address these challenges, affected countries can implement strategies such as expanding preventive therapy, strengthening the latent TB infection care cascade, enhancing health systems, and improving risk communication [51].

Tuberculosis is widely recognized as a disease driven by the social determinants of health. Populations in countries with low socioeconomic indicators are especially vulnerable to Mycobacterium tuberculosis infection. A country’s social conditions influence not only the risk of exposure and disease progression but also delays in diagnosis, treatment access, adherence, and overall outcomes. In this context, investing in public policies and targeted interventions is critical to interrupt transmission cycles and protect healthcare workers operating in high-risk environments [52].

The disparities in TB incidence rates among countries underscore the need for targeted public health strategies and equitable resource allocation, especially in regions with a high disease burden, such as Asia, Africa, and parts of Southeast Asia. It is important to emphasize that healthcare workers in high-endemicity areas face greater exposure to infection. Working conditions, whether in direct or indirect care settings, are also determinants of occupational risk. A study conducted in China found that precarious occupational environments are associated with high infection rates and that heavy workloads can increase occupational stress among healthcare workers [53].

Therefore, it is essential that health managers focus their efforts on the development of policies and programs aimed at protecting the health of healthcare workers, especially in contexts of greater vulnerability. The implementation of structural, administrative, and individual protective measures in the workplace can represent a significant advancement in addressing TB and reducing associated occupational risks.

In this regard, it is important to emphasize that the risk of acquiring TB in the workplace among healthcare professionals, especially those on the front lines, is real—particularly in countries with a high burden of the disease. Therefore, coordinated actions between these professionals and health managers are necessary to implement effective TB prevention strategies, reduce infection rates, and ensure appropriate and timely treatment.

In light of this context, it is also worth noting that systematic reviews represent the highest level of scientific evidence. This study strictly followed the recommendations of the Joanna Briggs Institute to gather evidence on the prevalence and factors associated with TB among healthcare workers. However, as with any research, some limitations must be considered: the results of this meta-analysis should be interpreted in light of the methodological quality of the included studies, and the observed heterogeneity among them limited the possibility of further comparisons.

5. Conclusions

This review provided relevant data on TB in health workers and helped to identify the risk factors associated with its infection. There is a need for early diagnosis of TB in the workplace and ongoing education with a rigorous preventive strategy to control contamination and spread, both in the workplace and in the social environment where the professional is inserted.