結核管理の推奨要素を実装している地域におけるMycobacterium tuberculosisの感染拡大
D P Chin1, C M Crane, M Y Diul
1Tuberculosis Control Branch and Microbial Disease Laboratory, California Department of Health Services, Berkeley, USA. chind@chn.wpro.who.int
JAMA
|June 24, 2000
まとめ
進行中のMycobacterium tuberculosisの伝播は,制御措置をとっても結核 (TB) を引き起こします. 早期の診断とよりよい接触者識別は,結核病の発症を予防するために極めて重要です.
科学分野:
- エピデミオロジー エピデミオロジー
- 感染症 感染症は感染症です.
- 公衆衛生は公衆衛生である.
背景:
- 結核 (TB) は,制御の努力にもかかわらず,米国では公衆衛生上の懸念事項であり続けています.
- マイコバクテリア結核の伝播は継続しており,新たな症例が発生しています.
研究 の 目的:
- 特定のM. tuberculosis株から結核病の発症の主な原因を特定する.
- 結核対策を講じられた地域社会における感染ダイナミクスを理解する.
主な方法:
- 都市部のサンフランシスコ・ベイ・エリアのコミュニティで,人口ベースの分子疫学研究が行われました.
- ゲノタイプ化と疫学的な関連付けにより,1996年から1997年の間に,単一のM. tuberculosis株によって引き起こされた結核の73例が特定されました.
主要な成果:
- 特定されたM.結核菌株は,コミュニティ内の結核症例の33%の原因となった.
- 疾患の発症の重要な要因には,接触者を特定できなかったこと (53%),発症源の診断が遅れたこと (27%) および接触者評価/治療に関する問題 (18%) が含まれていた.
- ほとんどの感染 (96%) は,診断前の2年以内に発生しました.
結論:
- 効果的な結核対策には,早期の患者診断と,より徹底した接触者の特定が必要です.
- 結核の継続的な伝播は,既設の結核予防プログラムがある地域でも継続しています.
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