Molecular epidemiology of tuberculosis among immigrants in Hamburg, Germany
Molecular epidemiology of tuberculosis among immigrants in Hamburg, Germany
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DOI：
10.1128/jcm.42.7.2952-2960.2004
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发表时间：
2004-07-01
影响因子：
9.4
通讯作者：
Niemann, S
中科院分区：
文献类型：
--
作者：
Diel, R;Rüsch-Gerdes, S;Niemann, S
为了研究居住在德国汉堡的外国出生个体的结核病（TB）特征，并发现外国出生个体对汉堡结核病发病率的贡献，通过经典和分子方法相结合进行了深入的流行病学研究。在1997年至2002年期间，共分析了796例结核病患者（占研究期间培养阳性结核病患者的88.7%）。其中，334名是来自43个不同国家的外国出生患者。其中只有31起是在入境时对12，176名寻求庇护者进行甄别后查明的。在外国出生的患者中，41.9%在德国居住超过5年。根据所有患者分离株的IS6110分型结果，将246例患者（31%）分为68个聚类，每个聚类包含2至38例患者。在外国出生的个人中，86人（26%）分布在40个集群中。在多变量分析中，以前的结核病接触史在外国出生的患者中聚集的预测风险最高，其次是吸毒成瘾，酒精依赖，寻求庇护者和失业。在形成一个聚集群的86名外国出生的成员中，有39名（45.3%）证实了最近传播的流行病学联系，其中包括16名来源患者和23名直接感染患者。在接受传统接触调查的2，227名先前已知的外国出生患者接触者中，14名外国出生的个体（0.6%）随后感染了培养确认的结核病，但只有9例传播可以通过IS6110分型确认（23例确诊的新感染中的39.1%通过IS6110分型回顾性确认）。总之，通过对寻求庇护者的筛查或传统的接触者追踪，在外国出生的个人中只有少数结核病病例被发现。最近的传播在汉堡移民中的结核病中没有发挥重要作用。
To study the characteristics of tuberculosis (TB) in foreign-born individuals living in Hamburg, Germany, and to discover in what way foreign-born individuals contribute to the incidence of TB in Hamburg, an in-depth epidemiological study was performed by a combination of classical and molecular methods. In total, 796 patients with TB were analyzed between 1997 and 2002 (88.7% of all patients with culture-positive TB in the study period). Of this total, 334 were foreign-born patients from 43 different countries. Of these, only 31 cases were identified as a consequence of the screening of 12,176 asylum seekers at entry. Of the foreign-born patients, 41.9% had been living in Germany for more than 5 years. On the basis of the IS6110 typing results for isolates from all patients, 246 patients (31%) were classified into 68 clusters, with each cluster containing from 2 to 38 patients. Among foreign-born individuals, 86 (26%) were represented in 40 clusters. In multi-variate analyses, a previous history as a TB contact had the highest predictive risk for clustering among foreign-born patients, followed by drug addiction, alcohol dependence, being an asylum seeker, and unemployment. Epidemiological links verifying recent transmission could be confirmed for 39 of the 86 foreign-born members (45.3%) who formed a cluster, comprising 16 source patients and 23 directly infected patients. Of 2,227 previously known contacts of foreign-born patients subjected to traditional contact investigation, 14 foreign-born individuals (0.6%) subsequently contracted culture-confirmed TB, but only 9 transmissions could be confirmed by IS6110 typing (39.1% of the 23 confirmed fresh infections retrospectively confirmed by IS6110 typing). In conclusion, only a minority of TB cases among foreign-born individuals are detected by screening of asylum seekers or conventional contact tracing. Recent transmission does not play an important role in TB among immigrants in Hamburg.