在直接观察治疗15年后,结核病传播的分子和地理模式
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
概括
巴尔的摩的结核病传播在很大程度上是最近发生的,超过三分之一的病例来自新的感染. 基于位置的公共卫生策略可能比传统的接触者追踪更有效地控制结核病的传播.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 传染病控制和控制传染病
背景情况:
- 最近的研究表明,很大一部分城市结核病 (TB) 病例是由于最近的传播引起的.
- 直接观察治疗 (DOT) 是一种关键的结核病控制措施,但其统一实施对最近传播的影响正在调查中.
研究的目的:
- 为了调查马里兰州巴尔的摩的结核病传播模式.
- 评估基于社区的直接观察治疗15年后的结核病传播动态.
主要方法:
- 一项为期30个月的前性,全市范围的研究 (1994年1月至1996年6月),涉及182名培养阳性结核病患者.
- 利用传统的接触调查,地理信息系统 (GIS) 和分子流行病学 (Mycobacterium结核病分离物的DNA指纹).
- 通过流行病学和分子联系定义最近传播的结核病;使用GIS数据确定了地理传播焦点.
主要成果:
- 分子分析显示,46% (84/182) 的结核病分离物聚集在一起,32% (58/182) 被定义为最近传播的.
- 只有24%的分子聚类病例有最近接触的直接流行病学证据.
- 在社会经济地位较低,毒品使用较高的地区,观察到相关,集群病例的显著空间聚合.
结论:
- 最近传播的结核病占巴尔的摩病例的很大一部分.
- 传染集群在地理上集中,这表明有针对性的,基于位置的干预措施.
- 基于位置的控制工作可能比传统的接触者追踪提供优势,用于早期结核病例的识别.
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