Networks and tuberculosis: an undetected community outbreak involving public places
Networks and tuberculosis: an undetected community outbreak involving public places
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DOI：
10.1016/s0277-9536(00)00170-2
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发表时间：
2001-03-01
影响因子：
5.4
通讯作者：
Musser, JM
中科院分区：
文献类型：
--
作者：
Klovdahl, AS;Graviss, EA;Musser, JM
在发达国家经历了几十年的衰落之后，结核病在1980年代中期卷土重来，同时人们越来越认识到，这种传染病长期以来一直是全球一级的一个主要公共卫生问题。来自分子生物学的新方法，特别是(结核分枝杆菌的)DNA‘指纹’，清楚地表明，当前的传播和最近的感染(与早期潜伏感染的重新激活形成对比)比之前认为的要重要得多。使用这些新工具对结核病暴发进行的研究指出了感染通过其传播的复杂网络，并强调需要采取新的方法进行暴发调查和疾病控制。在这里报道的这项研究中，一种新的方法--结合分子生物学、流行病学和网络分析的方法--被用来检查德克萨斯州休斯敦爆发的结核病。使用常规策略进行的初步调查显示，在37名具有相同(六条带)DNA(基于IS6110)指纹的患者中，几乎没有接触者，但随后的研究发现，此次疫情中的患者可能与40多个地方(包括许多同性恋酒吧)有关。使用网络方法重建疫情网络ACID，以量化在疫情中扮演角色的不同参与者(个人和地点)的相对重要性(这里是“之间的”中心)。多学科的工作为疫情调查和疾病控制的新方法提供了基础。(C)2001爱思唯尔科学有限公司。保留所有权利。
After decades of decline in developed countries, there was a resurgence of tuberculosis in the mid-1980s accompanied by increased recognition that this infectious disease has long remained a major public health problem at the global level. New methods from molecular biology, in particular DNA 'fingerprinting' (of Mycobacterium tuberculosis), made it clear that current transmission and recent infection (in contrast to reactivation of earlier, latent infection) were much more significant than previously believed. Studies of tuberculosis outbreaks using these new tools pointed to complex networks through which infection was spreading and highlighted the need for new approaches to outbreak investigation and disease control. In the study reported here a new approach - combining methods from molecular biology, epidemiology and network analysis - was used to examine an outbreak of tuberculosis in Houston, Texas. Initial investigation using conventional strategies revealed few contacts among 37 patients with identical (six-band) DNA (IS6110-based) fingerprints but subsequent research uncovered over 40 places (including many gay bars) to which patients in this outbreak could be linked. Network methods were used to reconstruct an outbreak network acid to quantify the relative importance (here, 'betweenness` centrality) of different actors (persons and places) playing a role in the outbreak. The multidisciplinary work provides the basis for a new approach to outbreak investigation and disease control. (C) 2001 Elsevier Science Ltd. All rights reserved.