Differences in contributing factors to tuberculosis incidence in US-born and foreign-born persons
Differences in contributing factors to tuberculosis incidence in US-born and foreign-born persons
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DOI：
10.1164/ajrccm.158.6.9804029
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发表时间：
1998-12-01
影响因子：
24.7
通讯作者：
Hopewell, PC
中科院分区：
文献类型：
--
作者：
Chin, DP;DeRiemer, K;Hopewell, PC
确定美国结核病发病率的因素-在加州的旧金山弗朗西斯科出生和外国出生的人群中，为了评估结核病控制工作在这些人群中的有效性，我们对367名携带最近引入该市的结核分枝杆菌菌株的患者进行了一项基于人群的分子流行病学研究。采用基于IS 6110和基于PGRS的限制性片段长度多态性（RFLP）分析方法对M.结核病分离株。分离株具有相同RFLP模式的患者被认为是一个簇。审查公共卫生和医疗记录，加上病人访谈，被用来确定集群病人之间传播的可能性。252例外国出生的病例中没有一例是最近（2年内）在该市感染的。115名美国人中有19名（17%）出生病例发生在该市最近的感染之后;只有两例是由外国出生的患者感染的。该城市最近感染的疾病涉及人类免疫缺陷病毒（HIV）感染、无家可归或药物滥用的来源或继发病例。未能确定接触者占继发病例的大多数。在旧金山弗朗西斯科，最近传播的M.结核病在外国出生的人中几乎已经消灭，但在美国还没有消灭。出生人口。需要加强对艾滋病毒感染者、无家可归者和吸毒者的接触者追踪和筛查活动，以进一步控制美国的结核病。出生人口。在外国出生和美国消除结核病-出生人口将需要广泛使用预防性治疗。
To determine the factors contributing to tuberculosis incidence in the U.S.-born and foreign-born populations in San Francisco, California, and to assess the effectiveness of tuberculosis control efforts in these populations, we performed a population-based molecular epidemiologic study using 367 patients with strains of Mycobacterium tuberculosis recently introduced into the city. IS6110-based and PGRS-based restriction fragment length polymorphism (RFLP) analyses were performed on M. tuberculosis isolates. Patients whose isolates had identical RFLP patterns were considered a cluster. Review of public health and medical records, plus patient interviews, were used to determine the likelihood of transmission between clustered patients. None of the 252 foreign-born cases was recently infected (within 2 yr) in the city. Nineteen (17%) of 115 U.S.-born cases occurred after recent infection in the city; only two were infected by a foreign-born patient. Disease from recent infection in the city involved either a source or a secondary case with human immunodeficiency virus (HIV) infection, homelessness, or drug abuse. Failure to identify contacts accounted for the majority of secondary cases. In San Francisco, disease from recent transmission of M. tuberculosis has been virtually eliminated from the foreign-born but not from the U.S.-born population. An intensification of contact tracing and screening activities among HIV-infected, homeless, and drug-abusing persons is needed to further control tuberculosis in the U.S.-born population. Elimination of tuberculosis in both the foreign-born and the U.S.-born populations will require widespread use of preventive therapy.