结核病的LTBI阴性密切接触者更有可能患上这种疾病:从集群爆发中获得启蒙和教训
Jingli Du1, Yue Su1, Enjun Dong1
1Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment, Senior Department of Tuberculosis, The Eighth Medical Center of PLA General Hospital, Beijing, China.
Frontiers in public health
|July 27, 2023
概括
这项研究调查了一所大学的结核病 (TB) 疫情,发现密切接触者中结核病隐性感染率高. 快速查和有针对性的干预措施对于预防结核病集群在群体生活环境中至关重要.
科学领域:
- 流行病学 流行病学
- 传染病控制和控制传染病
- 公共卫生 公共卫生
背景情况:
- 在公共生活环境 (如大学,养老院,监狱) 中预防和控制结核病 (TB) 存在独特的挑战,原因是年龄和环境因素增加了对结核病集群的易感性.
- 这些集群可以产生重大社会影响,需要有效的早期发现和管理策略.
- 这项研究重点是评估大学环境中的结核病集群爆发,以告知类似人群的改善控制策略.
研究的目的:
- 在大学环境中评估特定的结核病 (TB) 集群爆发流行病.
- 提供基于证据的建议,以加强针对居住在附近的人口的结核病控制策略.
主要方法:
- 进行了肺结核查和近距离接触调查,使用酸速染色,唾液培养,GeneXpert测试,结核素皮肤测试 (TST),干扰素马释放试验 (IGRA) 和胸部计算机断层扫描 (CT).
- 使用GraphPad Prism 9.5.1进行全面的数据分析,包括流行病数据的比率比较.
- 进行了密切接触者的初步查,随后根据初步发现和后续结果扩大了对一般接触者的查.
主要成果:
- 确定了源自一个指数病例的结核病集群爆发. 密切接触者的初步查显示,TST的阳性率高 (65.60%),TST的强阳性率高 (34.40%),TST的潜藏性结核感染 (LTBI) 高 (43.75%),以及IGRA (9.30%).
- 随访查发现了在密切接触者中发现的5例新活跃结核病例,转换了TST和/或IGRA结果,突出了感染进展的动态性.
- 扩展查显示,与一般接触者相比,在密切接触者中,TST,强阳性TST和LTBI的阳性率显著更高 (p <0.05),证实了集中传播.
结论:
- 在流行性结核病爆发期间,迅速识别感染源和及时查密切接触者至关重要.
- 最初的查应优先考虑没有LTBI的个体,他们有更高的发展到活跃结核病的风险.
- 考虑在群体环境中对纯化蛋白衍生物阴性个体进行额外的Bacille Calmette-Guérin (BCG) 疫苗接种或再接种疫苗,可能有助于预防结核病集群爆发.
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