School and household tuberculosis contact investigations in Swaziland: Active TB case finding in a high HIV/TB burden setting.
School and household tuberculosis contact investigations in Swaziland: Active TB case finding in a high HIV/TB burden setting.
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DOI：
10.1371/journal.pone.0178873
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Mandalakas AM
中科院分区：
文献类型：
--
作者：
Ustero PA;Kay AW;Ngo K;Golin R;Tsabedze B;Mzileni B;Glickman J;Wisile Xaba M;Mavimbela G;Mandalakas AM
国际指南广泛建议对接触传染性结核病（TB）的家庭接触者进行调查，以确定继发性结核病病例并限制传播。尽管有强有力的证据表明，大多数结核病感染发生在结核病高负担环境中的家庭以外，但几乎没有数据可以指导在家庭以外使用接触调查。在年龄较大的青少年中，估计大多数感染发生在学校。因此，作为在斯威士兰增加活跃病例发现项目的一部分，我们在发现一名感染性结核病的学生后进行了学校接触调查。2014年6月至2015年3月，布廷巴项目在6所不同的学校发现了7例青少年结核指数病例（10-20岁），这些病例经微生物证实患有结核病。除了家庭接触调查外，布廷巴项目工作人员还与斯威士兰学校卫生方案合作进行学校接触调查。在2015年5月至10月的6次学校结核病筛查活动中，选定的学生接受了自愿结核病筛查，症状筛查阳性的学生提供痰液进行结核病检测。在接受检测的2015名学生接触者中，177名（9%）结核病症状筛查呈阳性，132名（75%）提供了痰液样本，其中零名结核病检测呈阳性。对同一指示病例的家庭接触者调查发现40名接触者; 24人（60%）症状筛查呈阳性; 19人提供了痰液样本，其中1例确诊为结核病阳性。在学校暴露后，家庭与学校接触暴露后发生结核病的比值比显著降低（OR 0.0，95%CI 0.0至0.18，P = 0.02）。以学校为基础的接触调查需要进一步研究，以建立结核病高负担环境中的最佳做法。在这种情况下，一种基于结核病的筛查方法没有发现更多的结核病病例。相比之下，家庭接触者调查显示，结核病筛查阳性的接触者比例较高，并增加了一例结核病病例。
Investigation of household contacts exposed to infectious tuberculosis (TB) is widely recommended by international guidelines to identify secondary cases of TB and limit spread. There is little data to guide the use of contact investigations outside of the household, despite strong evidence that most TB infections occur outside of the home in TB high burden settings. In older adolescents, the majority of infections are estimated to occur in school. Therefore, as part of a project to increase active case finding in Swaziland, we performed school contact investigations following the identification of a student with infectious TB. The Butimba Project identified 7 adolescent TB index cases (age 10–20) with microbiologically confirmed disease attending 6 different schools between June 2014 and March 2015. In addition to household contact investigations, Butimba Project staff worked with the Swaziland School Health Programme (SHP) to perform school contact investigations. At 6 school TB screening events, between May and October 2015, selected students underwent voluntary TB screening and those with positive symptom screens provided sputum for TB testing. Among 2015 student contacts tested, 177 (9%) screened positive for TB symptoms, 132 (75%) produced a sputum sample, of which zero tested positive for TB. Household contact investigations of the same index cases yielded 40 contacts; 24 (60%) screened positive for symptoms; 19 produced a sputum sample, of which one case was confirmed positive for TB. The odds ratio of developing TB following household vs. school contact exposure was significantly lower (OR 0.0, 95% CI 0.0 to 0.18, P = 0.02) after exposure in school. School-based contact investigations require further research to establish best practices in TB high burden settings. In this case, a symptom-based screening approach did not identify additional cases of tuberculosis. In comparison, household contact investigations yielded a higher percentage of contacts with positive TB screens and an additional tuberculosis case.