Estimating the Burden of Tuberculosis among Foreign-Born Persons Acquired Prior to Entering the US, 2005-2009
Estimating the Burden of Tuberculosis among Foreign-Born Persons Acquired Prior to Entering the US, 2005-2009
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DOI：
10.1371/journal.pone.0027405
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发表时间：
2011-11-29
期刊：
影响因子：
3.7
通讯作者：
Moonan, Patrick K.
中科院分区：
文献类型：
--
作者：
Ricks, Philip M.;Cain, Kevin P.;Moonan, Patrick K.
背景：在美国境内的外国出生的结核病(TB)患者中，重新激活远程潜伏结核病感染(再激活结核病)的真正负担尚不清楚。我们的研究目标是估计外国出生的结核病患者的比例，并描述外国出生的结核病患者的特征。方法：我们对2005-2009年由美国国家结核病基因分型服务机构进行基因分型的结核分枝杆菌患者进行了横断面研究。如果结核病病例不是局部病例群的成员，则将其归因于重新激活的结核病。通过对具有匹配的TB基因结果的分离株的空间扫描统计来确定局部聚集区。使用粗略的优势比和95%的可信区间来评估外国出生的人中重新激活的结核病与选择因素的关系。主要结果：在报告的36,860例基因分型和监测数据中，22,151例(60%)是外国出生的。在外国出生的结核病患者中，18540人(83.7%)被归因于重新激活结核病。在外国出生的人中重新激活结核病与到达美国的年龄增加、原籍国的结核病发病率和确诊时在美国的时间减少有关。结论：外国出生的人中有五分之四的结核病病例可以归因于重新激活的结核病，这是美国消除结核病的最大挑战。在外国出生的人中的结核病控制策略应该侧重于在抵达美国之前或之后不久发现和治疗潜在的结核病感染，并通过改善全球结核病控制来减轻长期结核病治疗的负担。
Background: The true burden of reactivation of remote latent tuberculosis infection (reactivation TB) among foreign-born persons with tuberculosis (TB) within the United States is not known. Our study objectives were to estimate the proportion of foreign-born persons with TB due reactivation TB and to describe characteristics of foreign-born persons with reactivation TB.Methods: We conducted a cross-sectional study of patients with an M. tuberculosis isolate genotyped by the U. S. National TB Genotyping Service, 2005-2009. TB cases were attributed to reactivation TB if they were not a member of a localized cluster of cases. Localized clusters were determined by a spatial scan statistic of cases with isolates with matching TB genotype results. Crude odds ratios and 95% confidence intervals were used to assess relations between reactivation TB and select factors among foreign-born persons.Main Results: Among the 36,860 cases with genotyping and surveillance data reported, 22,151 (60%) were foreign-born. Among foreign-born persons with TB, 18,540 (83.7%) were attributed to reactivation TB. Reactivation TB among foreign-born persons was associated with increasing age at arrival, incidence of TB in the country of origin, and decreased time in the U. S. at the time of TB diagnosis.Conclusions: Four out of five TB cases among foreign-born persons can be attributed to reactivation TB and present the largest challenge to TB elimination in the U. S. TB control strategies among foreign-born persons should focus on finding and treating latent tuberculosis infection prior to or shortly after arrival to the United States and on reducing the burden of LTBI through improvements in global TB control.