TUBERCULOSIS IN NEW-YORK-CITY - TURNING THE TIDE
TUBERCULOSIS IN NEW-YORK-CITY - TURNING THE TIDE
复制标题
DOI：
10.1056/nejm199507273330406
复制
发表时间：
1995-07-27
影响因子：
158.5
通讯作者：
HAMBURG, MA
中科院分区：
文献类型：
--
作者：
FRIEDEN, TR;FUJIWARA, PI;HAMBURG, MA
背景资料。从1978年到1992年，纽约市的结核病患者数量几乎增加了两倍，具有耐药结核分枝杆菌分离株的患者比例增加了一倍以上。我们回顾、确认和分析了在结核病患者监测过程中获得的数据。从1992年到1994年，纽约市报告的肺结核病例减少了21%。对监测系统的评估显示，很少有未报告的病例。在黑人和西班牙裔、有记录的人类免疫缺陷病毒感染者、无家可归者和耐多药结核病患者中，病例数量减少了20%以上；在所有这些群体中，结核病很可能是最近传播的结果。相比之下，老年人和外国出生的人中结核病病例的数量增加了，这些人的疾病很可能是多年前获得的感染重新激活的结果。参加直接监督治疗的人数从不到100人增加到近1300人，从1992年到1994年进行了超过3.2万人月的观察。流行病学模式有力地表明，病例减少是由于结核分枝杆菌感染的持续传播中断，主要是因为治疗完成率较高和扩大了直接监督治疗的使用。另一个促成因素可能是在医院、收容所和监狱等机构环境中努力减少结核病的传播。需要扩大预防和控制结核病的措施，并支持国际控制努力，以确保继续取得进展。
Background. From 1978 through 1992, the number of patients with tuberculosis in New York City nearly tripled, and the proportion of such patients who had drug-resistant isolates of Mycobacterium tuberculosis more than doubled.Methods. We reviewed, confirmed, and analyzed data obtained during the surveillance of patients with tuberculosis.Results. From 1992 through 1994, there was a 21 percent decrease in reported cases of tuberculosis in New York City. An evaluation of the surveillance system revealed very few unreported cases. The number of cases decreased by more than 20 percent among blacks and Hispanics, persons with documented human immunodeficiency virus infection, homeless persons, and patients with multidrug-resistant tuberculosis; in all these groups, tuberculosis is likely to result from recent transmission. In contrast, the number of cases of tuberculosis increased among elderly and foreign-born persons, in whom the disease is likely to result from the reactivation of an infection acquired many years earlier. Enrollment in a program of directly observed therapy, in which health workers watch patients take their medications, increased from fewer than 100 patients to nearly 1300, with more than 32,000 patient-months of observation from 1992 through 1994.Conclusions. Epidemiologic patterns strongly suggest that the decrease in cases resulted from an interruption in the ongoing spread of M. tuberculosis infection, primarily because of better rates of completion of treatment and expanded use of directly observed therapy. Another contributing factor may have been efforts to reduce the spread of tuberculosis in institutional settings, such as hospitals, shelters, and jails. Expansion of measures to prevent and control tuberculosis and support of international control efforts are needed to ensure continued progress.