直接観察された治療による15年間の結核伝播の分子および地理的パターン
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
まとめ
ボルチモアの結核の伝播は最近の大部分で,症例の3分の1以上が新しい感染によるものです. 場所に基づいた公衆衛生戦略は,結核の蔓延を抑えるために,従来の接触者追跡よりも効果的かもしれません.
科学分野:
- 公衆衛生は公衆衛生である.
- エピデミオロジー エピデミオロジー
- 感染症のコントロール・コントロール
背景:
- 最近の研究によると,都市部における結核 (TB) 症例の有意な割合は,最近の感染によるものであることが示されています.
- 直接観察療法 (DOT) は結核対策の重要な手段ですが,その統一的な実施が最近の感染に与える影響については調査中です.
研究 の 目的:
- メリーランド州ボルチモアで結核の感染パターンを調査する.
- コミュニティベースの直接観察療法による15年間の結核伝播ダイナミクスを評価する.
主な方法:
- 都市規模で30ヶ月の前向き研究 (1994年1月~1996年6月) で,培養剤陽性結核患者の182人が参加した.
- 伝統的な接触調査,地理情報システム (GIS),および分子疫学 (Mycobacterium tuberculosis単離体のDNA指紋) を利用しました.
- 流行病学および分子関連によって最近感染した結核を定義し,GISデータを用いて地理的感染焦点を特定した.
主要な成果:
- 分子解析により,結核単離体の46% (84/182) がクラスタ化され,32% (58/182) が最近感染したと定義された.
- 分子的に集約された症例の24%だけが,最近の接触の直接的な流行病学的証拠を持っていた.
- 関連した,クラスター化された症例の重要な空間的集積は,社会経済的な地位が低く,薬物使用率が高い地域で観察されました.
結論:
- 最近感染した結核はボルチモアの症例の相当な割合を占めています.
- 伝播クラスターは地理的に集中しており,標的を絞り,場所に基づいた介入を提案しています.
- 場所に基づいた制御の取り組みは,早期のTB症例の特定のために,従来のコンタクト追跡よりも利点がある可能性があります.
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