Childhood tuberculosis infection and disease: a spatial and temporal transmission analysis in a South African township.
Childhood tuberculosis infection and disease: a spatial and temporal transmission analysis in a South African township.
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DOI：
10.7196/samj.3376
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发表时间：
2009-10
期刊：
影响因子：
--
通讯作者：
K. Middelkoop;L. Bekker;C. Morrow;E. Zwane;R. Wood
中科院分区：
文献类型：
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作者：
K. Middelkoop;L. Bekker;C. Morrow;E. Zwane;R. Wood
结核病（TB）仍然是南非死亡率和发病率的主要原因。虽然成人结核病是由最近和过去的感染引起的，但儿童结核病是由最近的感染引起的，反映了尽管目前有结核病控制战略，但仍在继续传播。背景：一个结核病和艾滋病发病率很高的南非社区。结果：使用地理信息系统在空间和时间上确定1997年至2007年期间在住宅小区中暴露于成人HIV阳性和HIV阴性结核病的15岁以下儿童的结核病暴露、感染和疾病之间的关系。结果在研究期间，成人结核病年报告率从629/10万上升到2106/10万，15岁以下儿童的报告率在664/10万和1044/10万之间。未感染结核病的儿童、潜伏感染结核病的儿童和结核病病例每年暴露于成人结核病的平均人数分别为5.1%、5.4%和33%，每个暴露儿童的成人涂阳病例平均人数分别为1.0、1.6和1.9。结核病感染的获得与儿童接触的成人结核病病例的艾滋病毒状态无关，36%的儿童结核病病例在他们的图上时间上最接近的成人病例之前被诊断出来。结论：在直接的社会网络中，儿童感染和疾病与传染性成人结核病患病率有定量联系。应在高负担环境中监测儿童感染情况，作为结核病持续传播的标志。对乡镇儿童和成人社交网络的进一步了解也可以促进有针对性的主动病例发现，这可能为目前失败的结核病控制战略提供辅助手段。
BACKGROUND Tuberculosis (TB) remains a leading cause of mortality and morbidity in South Africa. While adult TB results from both recent and past infection, childhood TB results from recent infection and reflects ongoing transmission despite current TB control strategies. SETTING A South African community with high rates of TB and HIV disease. OUTCOMES A Geographic Information System was used to spatially and temporally define the relationships between TB exposure, infection and disease in children < 15 years of age with exposure to adult HIV-positive and HIV-negative TB disease on residential plots between 1997 and 2007. RESULTS During the study period the annual adult TB notification rate increased from 629 to 2 106/100 000 and the rate in children aged < 15 years ranged between 664/100 000 and 1 044/100 000. The mean number of exposures to adult TB for TB-uninfected children, latently TB-infected children and TB cases were 5.1%, 5.4% and 33% per annum and the mean number of adult smear-positive cases per exposed child was 1.0, 1.6 and 1.9, respectively. Acquisition of TB infection was not associated with HIV status of the adult TB case to which the child was exposed, and 36% of child TB cases were diagnosed before the temporally closest adult case on their plot. CONCLUSIONS Childhood infection and disease were quantitatively linked to infectious adult TB prevalence in an immediate social network. Childhood infection should be monitored in high-burden settings as a marker of ongoing TB transmission. Improved knowledge of township childhood and adult social networks could also facilitate targeted active case finding, which may provide an adjunct to currently failing TB control strategies.