Tuberculosis-related stigma leading to an incomplete contact investigation in a low-incidence country
Tuberculosis-related stigma leading to an incomplete contact investigation in a low-incidence country
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DOI：
10.1017/s095026881400394x
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发表时间：
2015-10-01
影响因子：
4.2
通讯作者：
Filia, A.
中科院分区：
文献类型：
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作者：
Faccini, M.;Cantoni, S.;Filia, A.
在米兰（意大利）一家呼叫中心报告了一例传染性肺结核（TB）病例后，进行了接触调查，确定了过去5年内在同一工作场所的员工中发生的另外3例病例，其中1例为可能的源病例。还发现了33例潜伏感染。在诊断时，源病例由于害怕与结核病有关的耻辱，声称失业，没有在工作场所进行接触调查。通过结核分枝杆菌基因分型将病例联系起来。结核病耻辱感经常被描述，主要是在高发环境中，并且已知会影响寻求健康的行为和治疗的坚持。本报告的调查结果强调，结核病相关的耻辱感也可能导致接触调查不完整。在低发病率国家，对结核病相关污名的原因和影响知之甚少，这值得进一步探索。还需要进行研究，以评估具体的面谈技术和工作人员培训干预措施在减少结核病患者耻辱感方面的有效性。最后，疫情强调了将常规接触调查与基因分型相结合的重要性。
A contact investigation following a case of infectious tuberculosis (TB) reported in a call centre in Milan (Italy) led to the identification of three additional cases that had occurred in employees of the same workplace during the previous 5 years, one of whom was the probable source case. Thirty-three latent infections were also identified. At the time of diagnosis, the source case, because of fear of stigma related to TB, claimed to be unemployed and a contact investigation was not performed in the workplace. Cases were linked through genotyping of Mycobacterium tuberculosis. TB stigma has been described frequently, mainly in high-incidence settings, and is known to influence health-seeking behaviours and treatment adherence. The findings in this report highlight that TB-associated stigma may also lead to incomplete contact investigations. Little is known about the causes and impact of TB-related stigma in low-incidence countries and this warrants further exploration. Research is also needed to evaluate the effectiveness of specific interviewing techniques and training interventions for staff in reducing feelings of stigma in TB patients. Finally, the outbreak emphasizes the importance of integrating routine contact investigations with genotyping.