The prevalence of latent tuberculosis infection among healthcare workers in Saudi Arabia: a systematic review and meta-analysis.

OBJECTIVES

This systematic review and meta-analysis aimed to estimate the prevalence of latent tuberculosis infection (LTBI) among healthcare workers (HCWs) in Saudi Arabia and identify key associated risk factors.

METHODS

A systematic search of PubMed, Web of Science, and MEDLINE and Embase (via Ovid) was conducted for studies reporting LTBI prevalence among HCWs in Saudi Arabia. Data were pooled using a random-effects model. Subgroup analyses assessed variations by diagnostic method, professional category, and nationality.

RESULTS

The overall pooled prevalence was 24% (95% confidence interval [CI] = 16-34%), with high heterogeneity across studies (I² = 98.8%). Prevalence was numerically higher in tuberculin skin test (TST)-based studies (27%) than in interferon-gamma release assay (IGRA)-based studies (20%), although this difference did not reach statistical significance (P = 0.13). TST-positive/IGRA-negative discordance was the predominant pattern. Expatriate HCWs from high-burden countries showed prevalence rates of 45-46%, compared to 13% among Saudi nationals. Allied health professionals and nurses exhibited higher prevalence trends, though these did not reach statistical significance.

CONCLUSION

The LTBI burden among HCWs in Saudi Arabia is substantial and largely imported by expatriate workers from high-burden countries, with a possible secondary occupational contribution. TST-IGRA discordance suggests that TST may overestimate prevalence in this bacille Calmette-Guérin-vaccinated population. Based on discordance patterns and supporting evidence, transitioning to IGRA-based screening and implementing targeted surveillance for high-risk groups should be considered.