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背景:自1986年起在三分之一的捷克共和国内(每年3万新生儿)除结核病高危险的婴儿外,停止新生儿卡介苗普种。目的:在代表生活于良好社会经济条件下的未接种卡介苗儿童中评价了结核菌传播和感染的危险性。设计:1986-1992年每间隔两年进行结核菌素试验,在184648名儿童中283名被感染。结果:新感染率是低的(0.04％)。1岁以下儿童很少发生感染,2-3岁儿童感染率最高。仅仅一半的最小儿童和10％较大儿童家庭内发现传染源。其余儿童必须考虑偶然接触到的家庭外的传染源,但接触和传播的方式未能查明。使结核病传播的唯一因素是高密度人群。结论:在稳定人群没有明显危险因素的儿童中新感染率是低的,已查明的结核病传染源是罕见的。儿童通过偶然接触他们家庭外结核病例而被感染。生活在太拥挤的工业住宅区是造成未接种卡介苗儿童新感染的不利因素。
Background: Neonatal BCG vaccination is discontinued in one third of the Czech Republic (30,000 newborns a year) since 1986, except for infants at high risk for tuberculosis. Objectives: To assess the risk of transmission and infection of tuberculosis in unvaccinated BCG children who live in good socio-economic conditions. Design: Tuberculin tests were conducted every two years from 1986 to 1992, and 283 out of 186,648 children were infected. Results: The new infection rate is low (0.04%). Children under the age of 1 are infrequently infected, and children aged 2-3 are at the highest infection rates. Only half of the youngest children and 10% of older children’s families found a source of infection. The remaining children must consider incidental sources of infection outside the home, but the pattern of exposure and transmission can not be identified. The only factor driving TB spread is the high density of people. Conclusions: The prevalence of new infections is low among children in stable populations without significant risk factors, and proven sources of TB infection are rare. Children are infected by incidental contact with TB cases outside their home. Living in a crowded industrial complex is a detrimental factor for new infections in children who have not been vaccinated with BCG.