Tuberculosis outbreaks predicted by characteristics of first patients in a DNA fingerprint cluster
Tuberculosis outbreaks predicted by characteristics of first patients in a DNA fingerprint cluster
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DOI：
10.1164/rccm.200708-1256oc
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发表时间：
2008-07-01
影响因子：
24.7
通讯作者：
Borgdorff, Martien W.
中科院分区：
文献类型：
--
作者：
Kik, Sandra V.;Verver, Suzanne;Borgdorff, Martien W.
理由：某些携带具有相同 DNA 指纹图谱的结核分枝杆菌分离株的患者群比其他患者生长得更快。目前尚不清楚哪些预测因子决定簇增长。目的：评估是否可以通过前两名患者的特征来预测结核病 (TB) 暴发的发展。方法：将 1993 年至 2004 年荷兰所有经培养确诊的结核病患者的人口统计和临床数据与 DNA 指纹数据相结合。集群被限制为 2 年的集群事件，仅检测新出现的集群。比较小规模（2-4 例）和大规模（5 或更多病例）聚集性发作的前两名患者的特征。测量和主要结果：在 5,454 例聚集性病例中，1,756 例（32%）属于 2 年聚集性发作的一部分。在 622 起聚集性事件中，54 起（9%）为大型事件，568 起（91%）为小事件。大规模聚集性发作的独立预测因素如下：前两名患者的诊断间隔时间不到 3 个月，一名或两名患者都很年轻（< 35 岁），两名患者都居住在城市地区，两名患者都来自撒哈拉以南非洲地区。 结论：在荷兰，应对新的聚集性发作患者进行这些危险因素筛查。当风险模式适用时，应考虑采取有针对性的干预措施（例如加强接触者调查），以防止集群进一步扩张。
Rationale: Some clusters of patients who have Mycobacterium tuberculosis isolates with identical DNA fingerprint patterns grow faster than others. It is unclear what predictors determine cluster growth.Objectives: To assess whether the development of a tuberculosis (TB) outbreak can be predicted by the characteristics of its first two patients.Methods: Demographic and clinical data of all culture-confirmed patients with TB in the Netherlands from 1993 through 2004 were combined with DNA fingerprint data. Clusters were restricted to cluster episodes of 2 years to only detect newly arising clusters. Characteristics of the first two patients were compared between small (2-4 cases) and large (5 or more cases) cluster episodes.Measurements and Main Results: Of 5,454 clustered cases, 1,756 (32%) were part of a cluster episode of 2 years. Of 622 cluster episodes, 54 (9%) were large and 568 (91%) were small episodes. Independent predictors for large cluster episodes were as follows: less than 3 months' time between the diagnosis of the first two patients, one or both patients were young (< 35yr), both patients lived in an urban area, and both patients came from sub-Saharan Africa.Conclusions: In the Netherlands, patients in new cluster episodes should be screened for these risk factors. When the risk pattern applies, targeted interventions (e.g., intensified contact investigation) should be considered to prevent further cluster expansion.