Analysis of changes in recent tuberculosis transmission patterns after a sharp increase in immigration
Analysis of changes in recent tuberculosis transmission patterns after a sharp increase in immigration
复制标题
DOI：
10.1128/jcm.01644-06
复制
发表时间：
2007-01-01
影响因子：
9.4
通讯作者：
Chaves, Fernando
中科院分区：
文献类型：
--
作者：
Inigo, Jesus;Garcia de Viedma, Dario;Chaves, Fernando
我们在西班牙马德里（2002 年至 2004 年）开展了一项基于人群的结核病分子流行病学研究，以确定传播模式和与聚集相关的因素。我们特别关注近年来移民中结核病病例的增加（1997 年至 1999 年为 2.8%，本研究期间为 36.2%）如何改变传播模式。对从居住在马德里九个区的患者（1,459,232 名居民）获得的结核分枝杆菌分离株进行了基因分型。外国出生者的结核病发病率是西班牙出生者的三到四倍，从抵达到开始治疗的中位时间为22.4个月。在研究期间，227 名患者（36.3%）被分为 64 个集群，其中 115 名患者（50.7%）属于 21 个西班牙出生和外国出生的混合患者集群。 21个混合聚集性病例中，有3个占聚集性患者的21.1%。混合集群中的 38 名移民中，有 22 名 (57.9%) 感染了 1997 年至 1999 年在当地人口中已发现的结核菌株，其中包括三种最流行的菌株。被确定为聚类独立预测因素的因素包括无家可归（比值比 [OR]，2.3；95% 置信区间 [95% CI]，1.2 至 4.5；P = 0.011）和出生在西班牙（OR，1.8；95% CI，1.2 至 2.6；P = 0.002）。结果表明，(i) 西班牙出生的人中结核病传播率较高，主要与无家可归有关；(ii) 外国出生的人聚集的可能性要小得多，这表明在抵达西班牙之前感染的比例更高；(iii) 西班牙和外国出生的人群之间的广泛传播，主要由本土菌株引起，正在马德里发生。
We conducted a population-based molecular epidemiological study of tuberculosis (TB) in Madrid, Spain (2002 to 2004), to define transmission patterns and factors associated with clustering. We particularly focused on examining how the increase in TB cases among immigrants in recent years (2.8% in 1997 to 1999 to 36.2% during the current study) was modifying transmission patterns. Mycobacterium tuberculosis isolates obtained from patients living in nine districts of Madrid (1,459,232 inhabitants) were genotyped. The TB case rate among foreign-born people was three to four times that of Spanish-born people, and the median time from arrival to the onset of treatment was 22.4 months. During the study period, 227 (36.3%) patients were grouped in 64 clusters, and 115 (50.7%) of them were in 21 clusters with mixed Spanish-born and foreign-born patients. Three of the 21 mixed clusters accounted for 21.1% of clustered patients. Twenty-two of 38 (57.9%) immigrants in mixed clusters were infected with TB strains that had already been identified in the native population in 1997 to 1999, including the three most prevalent strains. Factors identified as independent predictors of clustering were homelessness (odds ratio [OR], 2.3; 95% confidence interval [95% CI], 1.2 to 4.5; P = 0.011) and to be born in Spain (OR, 1.8; 95% CI, 1.2 to 2.6; P = 0.002). The results indicated that (i) TB transmission was higher in Spanish-born people, associated mainly with homelessness, (ii) that foreign-born people were much less likely to be clustered, suggesting a higher percentage of infection before arriving in Spain, and (iii) that an extensive transmission between Spanish- and foreign-born populations, caused mainly by autochthonous strains, was taking place in Madrid.