Should neighbours of tuberculosis (TB) cases be prioritised for active case finding in high TB-burden settings? A prospective molecular epidemiological study.
IF 6.1 2区 医学Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Raspati C Koesoemadinata, Susan McAllister, Chuan-Chin Huang, Sri Hartati, Hanif Djunaedy, Nury Fitri Dewi, Lidya Chaidir, Bony Wiem Lestari, Panji Fortuna Hadisoemarto, Reinout Van Crevel, Megan B Murray, Bachti Alisjahbana, Philip C Hill
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引用次数: 0
Abstract
Introduction: In high tuberculosis (TB)-burden countries, considerable transmission of Mycobacterium tuberculosis (M. tb) likely occurs outside of households. We aimed to estimate the TB prevalence and incidence in households and neighbourhoods around known TB cases and to understand transmission patterns.
Methods: Household and neighbourhood contacts of pulmonary TB index cases from contiguous areas in Bandung, Indonesia, were screened and followed up for 12 months. Sputum samples underwent smear microscopy, M. tb culture, Xpert MTB/RIF, DNA isolation and whole-genome sequencing (WGS). Pairwise single-nucleotide polymorphism (SNP) distance ≤12 defined transmission for pairs with known epidemiological links, or SNP≤3 for pairs without epidemiological link. An SNP=12 cut-off was used to characterise transmission clusters.
Results: From 213 index cases, 514 household and 4141 neighbourhood contacts underwent TB screening: 19 household (3.70%, 95% CI 2.24 to 5.71) and 45 neighbourhood (1.09%, 95% CI 0.79 to 1.45) contacts were identified with TB, of whom 18 (3.50%, 95% CI 2.20 to 5.48) and 38 (0.92%, 95% CI 0.65 to 1.13) respectively, were bacteriologically confirmed. During follow-up, 11 household and 13 neighbourhood contacts were identified with TB (incidence per 100 000 person-years: 2286 (95% CI 1286 to 4148) and 350 (95% CI 190 to 563)), of whom 6 and 8, respectively, were bacteriologically confirmed (incidence per 100 000 person-years: 1247 (95% CI 560 to 2776) and 201 (95% CI 101 to 402)). A total of 223 patient M. tb isolates underwent WGS. Of 15 intra-household pairs, 8 (53.3%) were transmission pairs. Of 24 neighbour to index case pairs, 1 (4.2%) was a transmission pair. 11 of 19 transmission pairs shared no epidemiological link. We identified 25 M. tb genetic clusters from 205 mono-TB isolates overall.
Conclusion: Neighbours have lower prevalence and incidence of TB than household contacts, but twice as many cases. Very few received M. tb from their index case, suggesting uncontrolled community-wide transmission. Whole population active case finding may be necessary in high TB-burden settings.
导言：在结核病高负担国家，结核分枝杆菌的大量传播可能发生在家庭以外。我们的目的是估计已知结核病病例周围家庭和社区的结核病患病率和发病率，并了解传播模式。方法：对印度尼西亚万隆市连片地区肺结核指数病例的家庭和社区接触者进行筛查，随访12个月。对痰样本进行涂片镜检、结核分枝杆菌培养、Xpert MTB/RIF、DNA分离和全基因组测序（WGS）。对于已知有流行病学联系的配对，配对单核苷酸多态性（SNP）距离≤12定义传播，对于没有流行病学联系的配对，SNP≤3定义传播。采用SNP=12的截止值来表征传播集群。结果：在213例指标病例中，514名家庭接触者和4141名社区接触者接受了结核病筛查：19名家庭接触者（3.70%,95% CI 2.24 ~ 5.71）和45名社区接触者（1.09%,95% CI 0.79 ~ 1.45）被鉴定为结核病接触者，其中18名（3.50%,95% CI 2.20 ~ 5.48）和38名（0.92%,95% CI 0.65 ~ 1.13）分别被细菌学证实。在随访期间，11名家庭接触者和13名社区接触者被确定患有结核病（每10万人年发病率：2286人（95% CI 1286至4148）和350人（95% CI 190至563）），其中分别有6人和8人被细菌学证实（每10万人年发病率：1247人（95% CI 560至2776）和201人（95% CI 101至402））。共有223名结核分枝杆菌患者接受了WGS。15对家庭内感染对中，8对（53.3%）为传播对。在24对与索引病例相邻的病例中，1对（4.2%）为传播病例。19对传播中有11对没有流行病学联系。我们从205株单一结核分离株中鉴定出25个结核分枝杆菌遗传簇。结论：邻居结核病患病率和发病率低于家庭接触者，但病例数是家庭接触者的两倍。很少有人从其指示病例中感染结核分枝杆菌，这表明在社区范围内传播不受控制。在结核病高负担环境中，可能需要进行全人群主动病例发现。
期刊介绍：
BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.
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