Recent Transmission of Tuberculosis - United States, 2011-2014
Recent Transmission of Tuberculosis - United States, 2011-2014
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DOI：
10.1371/journal.pone.0153728
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发表时间：
2016-04-15
期刊：
影响因子：
3.7
通讯作者：
France, Anne Marie
中科院分区：
文献类型：
--
作者：
Yuen, Courtney M.;Kammerer, J. Steve;France, Anne Marie
结核病是一种传染病，可能由最近的传播或多年前获得的感染引起;没有诊断测试来区分这两种原因。从公共卫生的角度来看，最近传播的病例特别令人关切。为了描述美国最近的结核病传播，我们使用了一种经过现场验证的合理源病例方法来估计2011年1月至2014年9月期间可能由最近传播引起的病例。我们根据传输簇大小将病例分类为有限或广泛的近期传输。我们使用逻辑回归分析与近期传播相关的患者特征。在26，586例基因分型病例中，14%归因于近期传播，其中39%归因于近期广泛传播。归因于近期传播的病例负担在地理上具有异质性，结核病发病率预测性较差。最近的广泛传播与美洲印第安人/阿拉斯加原住民呈正相关（调整后的患病率[aPR] = 3.6（95%置信区间[CI] 2.9-4.4），夏威夷土著/太平洋岛民（aPR = 3.2，95% CI 2.3-4.5），黑人（aPR = 3.0，95% CI 2.6-3.5）和无家可归者（aPR = 2.3，95% CI 2.0-2.5）。近期广泛传播与外国出生呈负相关（aPR = 0.2，95% CI 0.2-0.2）。结核病控制工作应优先减少高风险人群中的传播。
Tuberculosis is an infectious disease that may result from recent transmission or from an infection acquired many years in the past; there is no diagnostic test to distinguish the two causes. Cases resulting from recent transmission are particularly concerning from a public health standpoint. To describe recent tuberculosis transmission in the United States, we used a field-validated plausible source-case method to estimate cases likely resulting from recent transmission during January 2011-September 2014. We classified cases as resulting from either limited or extensive recent transmission based on transmission cluster size. We used logistic regression to analyze patient characteristics associated with recent transmission. Of 26,586 genotyped cases, 14% were attributable to recent transmission, 39% of which were attributable to extensive recent transmission. The burden of cases attributed to recent transmission was geographically heterogeneous and poorly predicted by tuberculosis incidence. Extensive recent transmission was positively associated with American Indian/Alaska Native (adjusted prevalence ratio [aPR] = 3.6 (95% confidence interval [CI] 2.9-4.4), Native Hawaiian/Pacific Islander (aPR = 3.2, 95% CI 2.3-4.5), and black (aPR = 3.0, 95% CI 2.6-3.5) race, and homelessness (aPR = 2.3, 95% CI 2.0-2.5). Extensive recent transmission was negatively associated with foreign birth (aPR = 0.2, 95% CI 0.2-0.2). Tuberculosis control efforts should prioritize reducing transmission among higher-risk populations.