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Patrones moleculares y geográficos de la transmisión de la tuberculosis después de 15 años de terapia directamente
W R Bishai1, N M Graham, S Harrington
1Department of International Health, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD 21205-2103, USA. wbishai@jhsph.edu
JAMA
|December 1, 1998
Resumen
La transmisión de la tuberculosis en Baltimore es en gran medida reciente, con más de un tercio de los casos derivados de nuevas infecciones. Las estrategias de salud pública basadas en la ubicación pueden ser más efectivas que el rastreo de contactos tradicional para controlar la propagación de la tuberculosis.
Área de la Ciencia:
- Salud Pública La salud pública.
- Epidemiología La epidemiología.
- Control y Control de Enfermedades Infecciosas
Sus antecedentes:
- Estudios recientes indican que una proporción significativa de los casos de tuberculosis urbana (TB) surgen de una transmisión reciente.
- La terapia de observación directa (DOT) es una medida clave para el control de la tuberculosis, pero se está investigando el impacto de su implementación uniforme en la transmisión reciente.
Objetivo del estudio:
- Para investigar los patrones de transmisión de la tuberculosis en Baltimore, Maryland.
- Evaluar la dinámica de transmisión de la TB después de 15 años de terapia de observación directa basada en la comunidad.
Principales métodos:
- Un estudio prospectivo de 30 meses en toda la ciudad (enero de 1994-junio de 1996) en el que participaron 182 pacientes con tuberculosis con cultivo positivo.
- Utilizó investigaciones de contacto tradicionales, sistemas de información geográfica (SIG) y epidemiología molecular (huellas dactilares de ADN de aislamientos de Mycobacterium tuberculosis).
- TB recientemente transmitida definida por vínculos epidemiológicos y moleculares; focos de transmisión geográfica identificados utilizando datos de SIG.
Principales resultados:
- El análisis molecular reveló el 46% (84/182) de los aislados de TB agrupados, con el 32% (58/182) definido como recientemente transmitido.
- Solo el 24% de los casos agrupados molecularmente tenían evidencia epidemiológica directa de contacto reciente.
- Se observó una agregación espacial significativa de casos vinculados y agrupados en áreas con bajo estatus socioeconómico y alto consumo de drogas.
Conclusiones:
- La tuberculosis recientemente transmitida constituye una proporción sustancial de los casos en Baltimore.
- Los grupos de transmisión están geográficamente concentrados, lo que sugiere intervenciones específicas basadas en la ubicación.
- Los esfuerzos de control basados en la ubicación pueden ofrecer ventajas sobre el rastreo de contactos tradicional para la identificación temprana de casos de TB.
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