Risk Factors for Tuberculosis and Effect of Preventive Therapy Among Close Contacts of Persons With Infectious Tuberculosis
Risk Factors for Tuberculosis and Effect of Preventive Therapy Among Close Contacts of Persons With Infectious Tuberculosis
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DOI：
10.1093/cid/ciz438
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发表时间：
2020-04-15
影响因子：
11.8
通讯作者：
Mangura, Bonita
中科院分区：
文献类型：
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作者：
Reichler, Mary R.;Khan, Awal;Mangura, Bonita
背景。肺结核 (TB) 患者的密切接触者结核病发病率很高。方法。我们前瞻性地在美国/加拿大 9 个地点招募了结核病患者及其密切接触者。对结核病患者和接触者进行了访谈，以确定指示患者、接触者和接触结核病的风险因素。对接触者进行潜伏性结核感染 (LTBI) 和结核病评估，并检查 LTBI 治疗预防接触性结核病的有效性。结果。在 4490 名密切接触者中，结核病的多变量危险因素包括年龄 = 10 毫米、与指标患者共用卧室、接触超过 1 名指标患者以及指标患者体重减轻（每项 P < .05）。在 1406 名皮试阳性接触者中，446 名未开始治疗的人中有 49 名 (9.8%) 发展为结核病，443 名接受部分治疗的人中有 8 名 (1.8%) 发展为结核病，517 名完成治疗的人中有 1 名 (0.2%) 发展为结核病（分别为 1951、290 和 31 例/10 万人年；P < .001）。在美国/加拿大出生的人中有 4.2% 被诊断出结核病，而在外国出生的接触者中这一比例为 2.3% (P = .002)，美国/加拿大出生和外国出生且未开始治疗的接触者的结核病发病率分别为每 10 万人年 3592 例和 811 例 (P < .001)。结论。 LTBI 治疗对于预防传染性结核病患者的密切接触者中的结核病非常有效。确定了与接触性结核病风险增加相关的几个指标患者、接触者和暴露特征。这些发现有助于为接触者调查、LTBI 治疗和其他公共卫生预防工作提供信息。
Background. Close contacts of persons with pulmonary tuberculosis (TB) have high rates of TB disease.Methods. We prospectively enrolled TB patients and their close contacts at 9 US/Canadian sites. TB patients and contacts were interviewed to identify index patient, contact, and exposure risk factors for TB. Contacts were evaluated for latent TB infection (LTBI) and TB, and the effectiveness of LTBI treatment for preventing contact TB was examined.Results. Among 4490 close contacts, multivariable risk factors for TB were age = 10 mm, shared bedroom with an index patient, exposure to more than 1 index patient, and index patient weight loss (P < .05 for each). Of 1406 skin test-positive contacts, TB developed in 49 (9.8%) of 446 who did not initiate treatment, 8 (1.8%) of 443 who received partial treatment, and 1 (0.2%) of 517 who completed treatment (1951, 290, and 31 cases/100 000 person-years, respectively; P < .001). TB was diagnosed in 4.2% of US/Canadian-born compared with 2.3% of foreign-born contacts (P = .002), and TB rates for US/Canadian-born and foreign-born contacts who did not initiate treatment were 3592 and 811 per 100 000 person-years, respectively (P < .001).Conclusions. Treatment for LTBI was highly effective in preventing TB among close contacts of infectious TB patients. Several index patient, contact, and exposure characteristics associated with increased risk of contact TB were identified. These findings help inform contact investigation, LTBI treatment, and other public health prevention efforts.