Drivers of Tuberculosis Transmission.
Drivers of Tuberculosis Transmission.
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DOI：
10.1093/infdis/jix354
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发表时间：
2017-11-03
期刊：
影响因子：
--
通讯作者：
Wood R
中科院分区：
文献类型：
--
作者：
Mathema B;Andrews JR;Cohen T;Borgdorff MW;Behr M;Glynn JR;Rustomjee R;Silk BJ;Wood R
测量结核病传播是非常困难的，因为结核分枝杆菌感染后临床疾病发生的时间有很大的差异;偶发疾病可能是最近（即几周到几个月）或遥远（即几年到几十年）的感染事件造成的。虽然我们不能确定的时间和地点的结核病传播的个人，估计个人的概率最近的传播和估计结核病病例的比例，由于最近在人群中传播的方法已经开发出来。用于估计近期传播可能负担的数据包括幼儿结核病例报告以及结核菌素皮肤试验和干扰素γ释放试验的趋势。最近，M。结核病全基因组测序已被用于估计最近的人口传播水平，确定社区内特定菌株的分布，并破译培养阳性结核病病例的传播链。推动结核病在社区传播的因素取决于流行结核病的负担;个人生活、工作和互动的方式（例如，聚集环境）;以及医疗保健和公共卫生系统识别和有效治疗结核病感染者的能力。在这里，我们提供了这些因素的概述，描述了测量持续传播的工具，并强调必须解决的知识差距。
Measuring tuberculosis transmission is exceedingly difficult, given the remarkable variability in the timing of clinical disease after Mycobacterium tuberculosis infection; incident disease can result from either a recent (ie, weeks to months) or a remote (ie, several years to decades) infection event. Although we cannot identify with certainty the timing and location of tuberculosis transmission for individuals, approaches for estimating the individual probability of recent transmission and for estimating the fraction of tuberculosis cases due to recent transmission in populations have been developed. Data used to estimate the probable burden of recent transmission include tuberculosis case notifications in young children and trends in tuberculin skin test and interferon γ–release assays. More recently, M. tuberculosis whole-genome sequencing has been used to estimate population levels of recent transmission, identify the distribution of specific strains within communities, and decipher chains of transmission among culture-positive tuberculosis cases. The factors that drive the transmission of tuberculosis in communities depend on the burden of prevalent tuberculosis; the ways in which individuals live, work, and interact (eg, congregate settings); and the capacity of healthcare and public health systems to identify and effectively treat individuals with infectious forms of tuberculosis. Here we provide an overview of these factors, describe tools for measurement of ongoing transmission, and highlight knowledge gaps that must be addressed.
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