肺结核呼吸道隔离对减少社区传播的影响:系统性审查
Ruvandhi R Nathavitharana1, Abarna Pearl1, Amanda Biewer1
1Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
概括
对结核病 (TB) 呼吸道隔离的证据有限,特别是在治疗开始后. 公共卫生指导必须平衡结核病传播预防与隔离对患者的重大负面影响,包括心理健康和社会福祉.
科学领域:
- 公共卫生 公共卫生
- 传染病流行病学 传染病流行病学
- 卫生政策 卫生政策
背景情况:
- 呼吸道隔离是预防社区结核病 (TB) 传播的关键策略.
- 目前关于隔离时间的指导方针是有限的,导致实施异质.
- 本次审查旨在综合证据,为国家结核病指南提供信息.
研究的目的:
- 系统地审查有关肺结核 (TB) 呼吸道隔离的有效性和影响的证据.
- 为结核病隔离实践制定基于证据的指导方针提供信息.
主要方法:
- 对6个数据库进行了系统审查.
- 8名审查员对结核病传播,死亡率,成本和心理健康影响等结果提取了数据.
- 一种融合的综合方法合成了定量和定性发现.
主要成果:
- 有限的直接比较数据存在于呼吸道隔离与没有隔离,特别是治疗后的启动.
- 建模研究表明潜在的传播减少,但有假设;一个RCT在接触者中没有发现结核病发病率的差异.
- 定性研究强调了孤立对就业,教育,粮食安全,心理健康,耻辱和社会孤立的不利影响,不成比例地影响了边缘化群体.
结论:
- 缺乏可靠的数据支持当前的肺结核呼吸道隔离实践,特别是在有效治疗后.
- 关于呼吸道隔离的公共卫生决策应该仔细考虑对个人的不利影响,以防止社区传播的潜在减少.
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