Evaluation of a model for efficient screening of tuberculosis contact subjects
Evaluation of a model for efficient screening of tuberculosis contact subjects
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DOI：
10.1164/rccm.200711-1756oc
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发表时间：
2008-05-01
影响因子：
24.7
通讯作者：
Delacourt, Christophe
中科院分区：
文献类型：
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作者：
Aissa, Khaoula;Madhi, Fouad;Delacourt, Christophe
理由：接触者追踪是结核病控制计划的重要组成部分。标准化的接触调查协议，可以使他们更efficient.Objectives：建立一个模型，选择接触科目screening.Methods：我们前瞻性地收集了标准化的数据，325结核病指数的情况下，他们的2,009接触。模型中包括了独立影响结核感染风险的因素，然后在第二个前瞻性队列中对88例结核病例及其618名接触者进行了验证。测量和主要结果：共确定了8个独立的风险因素（比值比; 95%置信区间）：年龄，3个亚组：6-14岁（3.6; 1.6-8.0）; 15-29岁（3.7; 1.8-7.7）; ≥ 30年（4.1; 2.0-8.5）;索引病例胸片上的空洞（1.6; 1.1-2.2）;指示病例痰涂片中抗酸杆菌≥ 100个/视野（1.8; 1.2-2.8）;夜间与住户接触（2.1; 1.3-3.2）;与指示病例有一级亲属关系（2.1; 1.3-3.3）;接触者主动吸烟（1.6; 1.1-2.4）;免费医疗（2.0; 1.2-3.2）;在结核病发病率高于25/10万的国家出生（2.2，1.5-3.2）。选择预测概率以确保假阴性率低于估计的TB感染背景。结论：本研究提供了一种标准化的接触者筛查模式，在不影响疾病控制的前提下，减少了所需的资源。
Rationale: Contact tracing is an important component of tuberculosis (TB) control programs. Standardization of contact investigation protocols can make them more efficient.Objectives: To develop a model to select contact subjects for screening.Methods: We prospectively collected standardized data on 325 TB index cases and their 2,009 contacts. Factors that independently influenced the risk of TB infection were included in the model, which was then validated in a second prospective cohort of 88 cases of TB and their 618 contacts.Measurements and Main Results: A total of eight independent risk factors were identified (odds ratio; 95% confidence interval): age, with three subgroups: 6-14 years (3.6; 1.6-8.0); 15-29 years (3.7; 1.8-7.7); >= 30 years (4.1; 2.0-8.5); cavitation on the index case's chest radiograph (1.6; 1.1-2.2); an index case sputum smear with 100 or more acid-fast bacilli per field (1.8; 1.2-2.8); household contact at night (2.1; 1.3-3.2); first-degree family relationship with the index case (2.1; 1.3-3.3); active smoking by the contact (1.6; 1.1-2.4); free health care (2.0; 1.2-3.2); and birth in a country with TB incidence rate higher than 25 of 100,000 (2.2, 1.5-3.2). Predictive probabilities were chosen to ensure false-negative rates lower than estimated TB infection background. The number of contacts to be investigated was reduced by 26% while maintaining a false-negative rate of 8%.Conclusions: This study provides a standardized contact screening model which reduces resources required without negatively affecting disease control.