Classen C N, Warren R, Richardson M, Hauman J H, Gie R P, Ellis J H, van Helden P D, Beyers N
Department of Anthropology/Sociology, University of the Western Cape, South Africa.
Thorax. 1999 Feb;54(2):136-40. doi: 10.1136/thx.54.2.136.
Tuberculosis (TB) is transmitted by close contact with an infectious person. It is assumed that close contact occurs amongst household members and that contact outside the house is "causal" and does not play a major role in the transmission of TB.
This study was conducted in an impoverished area with a high incidence of TB and a low HIV seropositive prevalence. Thirty three households with 84 TB patients were identified between February 1993 and April 1996 and the transmission of TB was studied by combining Mycobacterium tuberculosis fingerprinting with in depth sociological interviews.
Forty two strain genotypes were identified in the 84 patients. In 15 households all the patients had identical strains, in nine households all the patients had different strains, and in nine households some patients had identical strains and one had a different strain. In 26 houses at least one patient had a strain which formed part of a larger community cluster and in 12 of these households the patient(s) had contact with a community member who had the identical strain. In 58% of the cases the contact took place while drinking in social groups.
In high incidence areas contact outside the household may be important for the transmission of TB. This contact often takes place during recreation which, in the case of this study of impoverished people, consisted of drinking in social groups. Social interaction patterns should be studied and understood for effective implementation of control strategies.
结核病通过与感染者密切接触传播。一般认为密切接触发生在家庭成员之间，而户外接触是“偶然的”，在结核病传播中不起主要作用。
本研究在一个结核病高发且艾滋病毒血清阳性率低的贫困地区开展。1993年2月至1996年4月期间，共识别出33户家庭中的84名结核病患者，并结合结核分枝杆菌指纹识别技术和深入的社会学访谈对结核病传播进行研究。
84名患者中识别出42种菌株基因型。15户家庭中所有患者的菌株相同，9户家庭中所有患者的菌株不同，9户家庭中部分患者的菌株相同，另一名患者的菌株不同。26户家庭中至少有一名患者的菌株属于一个更大的社区集群，其中12户家庭中的患者与具有相同菌株的社区成员有接触。58%的接触发生在社交场合饮酒时。
在高发病地区，户外接触可能对结核病传播很重要。这种接触通常发生在娱乐活动期间，在本贫困人群研究中，娱乐活动包括社交场合饮酒。为有效实施控制策略，应研究和了解社会互动模式。
