论文部分内容阅读
地点:2002-2003年,在华盛顿King县,结核病(TB)在多个收容所的人群中大规模爆发。目的:控制结核病在多个地点的传播。设计:2002年,对收容所病人的接触者进行筛查,作结核菌素皮试(TSTs)和症状回顾。根据这些筛查的结果,确定和优选传播的地点。2003年,对暴露于这些点的队列作彻底的筛查(例如,症状回顾, TST,胸部X线检查[CXR],痰检和痰培养)。利用PCR为基础的方法对从病人那里分离出来的结核分枝杆菌作基因分型,以快速确认爆发相关病人。结果:2002-2003年,King县313例确诊的病人中有48例(15％)与爆发相关;通过基因分型,47例培阳病人分离出和爆发相匹配的菌株。3个收容所由于在2002年接纳的病人超过12人,所以人群中TST阳性率(约30％)高于收容所中的一般水平(7％)。用一个痰培养筛查接触者和CXR发现结核病人的敏感度相似(分别为77％和62％)。结论:一个广泛的资源密集的途径可能有助于控制疾病的传播。这次爆发突显出无家可归者的脆弱性和在城市维持强有力的结核病规划的必要性。
Location: Between 2002 and 2003, in King County, Washington, tuberculosis (TB) broke out on a large scale in groups of shelters. Purpose: To control the spread of tuberculosis in multiple locations. Design: In 2002, contacts of asylum patients were screened for tuberculin skin test (TSTs) and symptom review. Based on the results of these screening, identify and prioritize the site of transmission. In 2003, the cohorts exposed at these sites were thoroughly screened (eg, symptom review, TST, chest X-ray [CXR], sputum screening and sputum culture). PCR-based methods were used to genotype M. tuberculosis isolated from patients to quickly confirm the outbreak-related patients. RESULTS: Between 2002 and 2003, 48 (15%) of the 313 confirmed cases in King County were associated with an outbreak. By genotyping, 47 strains of patients with Pei-Yang were identified as isolates that matched the outbreak. The three shelters, as more than 12 patients were admitted in 2002, have a higher prevalence of TST (approximately 30%) in the population than in the shelter (7%). Similar sensitivities (77% and 62%, respectively) were found for sputum culture screening contacts and CXR-detected TB patients. Conclusion: An extensive resource-intensive approach may help to control the spread of disease. The outbreak highlighted the vulnerability of the homeless and the need to maintain a strong tuberculosis program in the city.