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背景:荷兰对所有来自结核病高流行国家的移民必须进行X线筛查,2年内自愿接受每年年一次的随访。 目的:评价移民筛查对减少结核病传播的作用。 设计:所有在1994年至1999年间经细菌学确诊的、分支杆菌分离株显示为DNA指纹相同的结核病患者认为是同一簇。假设成簇是近期传播的结果,认为首发病例为传染源。在来自结核病高流行国家的肺结核患者中,传染源的特征与非成簇患者相比较。 结果:在所入选的1438名患者中,187(13％)为簇中的首发病例。386(27％)在簇中但不是首发病例。865(60％)不成簇。成为一簇中首发病例的独立危险因素是:低年龄、国籍、早期诊断、长时间的治疗和没有并发肺外结核,Vnivarite分析显示:被动发现和在荷兰长期居住的患者成为一簇的首发病例分别比筛查发现和新入境的患者要多。而且,这些变量相关性很强。 结论:移民的筛查可以减少结核病的传播。这个结果有居住时间混杂因素的部分影响。 关键词:结核病;传播;分子流行病学;筛查;移民
Background: All immigrants from countries with a high prevalence of tuberculosis must be screened by X-rays and voluntarily undergo annual biannual visits within 2 years. Purpose: To evaluate the role of immigration screening in reducing the spread of tuberculosis. Design: All tuberculosis patients with mycobacterial isolates that were diagnosed as having the same DNA fingerprinting between 1994 and 1999 were considered the same cluster. Assuming clustering is the result of recent transmission, the initiating case is considered a source of infection. In patients with tuberculosis from countries with a high prevalence of tuberculosis, the characteristics of the source of infection were compared with non-clustered patients. Results: Of the 1438 patients enrolled, 187 (13%) were the first cases in the cluster. 386 (27%) in the cluster but not in the first case. 865 (60%) are not clustered. The independent risk factors that led to the first episode in a cluster were low age, nationality, early diagnosis, prolonged treatment and absence of concurrent extrapulmonary tuberculosis. Vnivarite analysis showed that passive discovery and long-term residence in the Netherlands became a cluster of initiating cases Respectively, more than those found and newly admitted to screening. Moreover, these variables are highly relevant. Conclusion: Immigration screening can reduce the spread of tuberculosis. This result has a partial effect of confounding factors of residence time. Keywords: Tuberculosis; Transmission; Molecular epidemiology; Screening; Immigration