南アフリカの金鉱のコミュニティにおける結核制御と分子疫学
P Godfrey-Faussett1, P Sonnenberg, S C Shearer
1Department of Medicine, University Teaching Hospital, Lusaka, Zambia. peter.godfrey-faussett@lshtm.ac.uk
Lancet (London, England)
|September 29, 2000
まとめ
ゴールドマイナーにおける結核の症例の大半は,輸入感染ではなく,コミュニティでの感染によるものです. 以前の治療が失敗した個人は,現在進行中の結核の拡散の鍵であり,改善された制御戦略を必要とします.
科学分野:
- エピデミオロジー エピデミオロジー
- 分子生物学は分子生物学である.
- 公衆衛生は公衆衛生である.
背景:
- ゴールドマイナーでは結核の発生率が高くなります.
- 鉱山コミュニティにおける結核伝染の起源 (輸入 vs. 地元) は不明である.
- 伝播のダイナミクスを理解することは,効果的な結核対策戦略に不可欠です.
研究 の 目的:
- 金鉱夫における結核の発生に地域感染の寄与を調査する.
- 結核の伝播集団に関連した危険因子を特定する.
主な方法:
- 分子流行病学と従来の流行病学を組み合わせた将来的な,人口ベースの研究です.
- IS6110のDNA指紋は,結核の伝播群を定義するために使用されました.
- 集団結核症例と非集団結核症例のリスク要因を比較した.
主要な成果:
- 結核症例の少なくとも50%は,コミュニティ内での感染によるものです.
- 以前の治療の失敗は,伝播クラスタに入ることと有意に関連していました.
- 多剤耐性結核は,薬剤感受性菌株と比較してクラスタ化する可能性が低い.
結論:
- 輸入された症例ではなく,継続的なコミュニティ感染が,この金鉱の環境で結核の流行を推進しています.
- 以前の治療が失敗した個人は,現在進行中の結核の伝播の重要な源です.
- 現在の世界保健機関 (WHO) の治癒率の目標は,この高リスク集団における結核の伝播を止めるには不十分である.
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