孟加拉国接触者中的风险因素和麻风病发病率:多层次分析
Unnati Rani Saha1, Abu Sufian Chowdhury2, Johan Chandra Roy2
1Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
在BCG接种后添加单剂量里法素 (SDR) 并没有显著减少接触者的麻风病例. 然而,SDR在多菌性 (MB) 麻风患者的接触者中显示出预防麻风的有效性.
科学领域:
- 传染性疾病
- 流行病学
- 公共卫生
背景情况:
- 在马尔塔莱普试验中,研究了一次单剂量里法素 (SDR) 疫苗接种后8至12周的疗效.
- 这项研究旨在确定SDR是否可以预防新诊断的麻风患者的接触者多发麻风病例.
研究的目的:
- 评估Maltalep试验的五年后续结果,以评估SDR在预防麻风的有效性.
- 对马尔塔莱普试验和同时进行的非干预性队列研究进行二次统计分析,以了解长期的BCG效应.
主要方法:
- 一个集群随机对照试验 (马尔塔勒普试验),有两个分支:SDR+ (在BCG后给予SDR) 和SDR- (在BCG后没有SDR).
- 一个同时进行的非干预性队列研究.
- 以各种风险因素进行调整后期的二次统计分析.
主要成果:
- 在Maltalep试验中,SDR+和SDR-手臂在5年间的麻风发病率没有显著的差异.
- 与Maltalep试验接触者相比,非干预队列中的麻风病发病率明显高 (1.70倍).
- 与SDR接触者相比,SDR+接触者在特定亚组 (MB,涂抹阳性,血液相关指数患者) 中的麻风发病率显著降低.
结论:
- 接种BCG疫苗有效预防麻风病,但在BCG之后添加SDR在减少多余病例方面没有明显的整体益处.
- 在多菌体 (MB) 和涂抹阳性指数患者以及二级血亲的接触者中,BCG后的SDR显示有效预防麻风.
- 在接触者中,遗传亲属性比单独的家庭亲密关系更为重要.
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