1 Title: Tuberculosis in healthcare workers in the UK: A cohort analysis 2009 to 2013 Authors: Jennifer A Davidson 1 , Maeve K Lalor 1 , Laura F Anderson 1,2 , Surinder Tamne 1 , Ibrahim Abubakar 1 , H Lucy Thomas 1 1. Respiratory Diseases Department Centre for Infectious Disease Surveillance and Control National Infection Service Public Health England London UK 2. Global TB World Health Organization Geneva Switzerland 3. Centre for Infectious Disease Epidemiology University College London London UK Corresponding author details: Jennifer A Davidson Public Health England 61 Colindale Avenue London NW9 5EQ jennifer.davidson@phe.gov.uk 020 832 77610 Key words: Healthcare worker, Tuberculosis, Transmission, Nosocomial infection, Occupational Health Word count: 3,492 What is the key question? Are healthcare workers (HCWs) at increased risk of TB due to occupational exposure in the UK? What is the bottom line? Although HCW in the UK have an overall higher incidence of TB than non- HCW, they do not have a higher incidence after stratifying by country of birth; this, combined with the evidence of very few transmission events in the healthcare setting, suggests that TB in HCW in the UK is not generally acquired through UK occupational exposure. Why read on? This is the first national study of TB in HCW in the UK which is able to investigate the incidence of TB in HCW in the UK after adjusting for country of birth, and incorporating genotyping data on recent transmission events; the findings have important implications for occupational health guidance on the prevention of TB in HCW.