Transmission network analysis to complement routine tuberculosis contact investigations
Transmission network analysis to complement routine tuberculosis contact investigations
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DOI：
10.2105/ajph.2005.071936
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发表时间：
2007-03-01
影响因子：
12.7
通讯作者：
McElroy, Peter D.
中科院分区：
文献类型：
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作者：
Andre, McKenzie;Ijaz, Kashef;McElroy, Peter D.
Objective.我们研究了网络分析的可行性和价值，以补充常规结核病（TB）接触调查程序在爆发期间。我们查阅了医院、卫生部门和监狱的记录，并采访了结核病患者。对结核分枝杆菌分离株进行基因分型。我们评估了结核病患者的潜伏性结核感染（LTBI）和结核病接触者，并分析了常规接触者调查数据，包括结核菌素皮肤试验（TST）结果。结果包括识别的接触者数量、评价的接触者数量及其TST状态。我们使用网络分析可视化和指标（范围，程度，介数）来表征爆发。该指示患者的症状持续了8个月，与37名继发性结核病患者和1200多名接触者有关。基因分型检测到一个21带模式的菌株W变异。没有发现艾滋病毒感染者。通过网络分析确定优先级的联系人比非优先级联系人更容易发生LTBI（比值比=7.8; 95%置信区间= 1.6，36.6）。网络可视化和指标突出显示了对维持疫情至关重要的患者，并有助于对接触者进行优先评估。结核病接触者调查的网络知情方法为检查大量数据提供了一种新的手段，并有助于重点控制结核病。
Objective. We examined the feasibility and value of network analysis to complement routine tuberculosis (TB) contact investigation procedures during an outbreak.Methods. We reviewed hospital, health department, and jail records and interviewed TB patients. Mycobacterium tuberculosis isolates were genotyped. We evaluated contacts of TB patients for latent TB infection (LTBI) and TB, and analyzed routine contact investigation data, including tuberculin skin test (TST) results. Outcomes included number of contacts identified, number of contacts evaluated, and their TST status. We used network analysis visualizations and metrics (reach, degree, betweenness) to characterize the outbreak.Results. The index patient was symptomatic for 8 months and was linked to 37 secondary TB patients and more than 1200 contacts. Genotyping detected a 21-band pattern of a strain W variant. No HIV-infected patients were diagnosed. Contacts prioritized by network analysis were more likely to have LTBI than non-prioritized contacts (odds ratio=7.8; 95% confidence interval= 1.6, 36.6). Network visualizations and metrics highlighted patients central to sustaining the outbreak and helped prioritize contacts for evaluation.Conclusions. A network-informed approach to TB contact investigations provided a novel means to examine large quantities of data and helped focus TB control.