Moss A R, Hahn J A, Tulsky J P, Daley C L, Small P M, Hopewell P C
Department of Epidemiology, Biostatistics, and Medicine, University of California San Francisco, San Francisco, USA.
Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):460-4. doi: 10.1164/ajrccm.162.2.9910055.
We set out to determine tuberculosis incidence and risk factors in the homeless population in San Francisco. We also examined the transmission of tuberculosis by molecular methods. We followed a cohort of 2,774 of the homeless first seen between 1990 and 1994. There were 25 incident cases during the period 1992 to 1996, or 270 per 100,000 per year (350/100,000 in African Americans, 450/100,000 in other nonwhites, 60/100,000 in whites). Ten cases were persons with seropositive HIV. Independent risk factors for tuberculosis were HIV infection, African American or other nonwhite ethnicity, positive tuberculin skin test (TST) results, age, and education; 60% of the cases had clustered patterns of restriction fragment length polymorphism, thought to represent recent transmission of infection with rapid progression to disease. Seventy-seven percent of African-American cases were clustered, and 88% of HIV-seropositive cases. The high rate of tuberculosis in the homeless was due to recent transmission in those HIV-positive and nonwhite. African Americans and other nonwhites may be at high risk for infection or rapid progression. Control measures in the homeless should include directly observed therapy and incentive approaches, treatment of latent tuberculous infection in those HIV-seropositive, and screening in hotels and shelters.
我们着手确定旧金山无家可归人群中的结核病发病率及风险因素。我们还通过分子方法研究了结核病的传播情况。我们追踪了1990年至1994年间首次就诊的2774名无家可归者队列。在1992年至1996年期间有25例新发病例，即每年每10万人中有270例（非裔美国人中为350/10万，其他非白人中为450/10万，白人中为60/10万）。10例患者HIV血清学检测呈阳性。结核病的独立风险因素包括HIV感染、非裔美国人或其他非白人种族、结核菌素皮肤试验（TST）结果呈阳性、年龄和教育程度；60%的病例具有限制性片段长度多态性的聚集模式，被认为代表感染的近期传播且疾病进展迅速。77%的非裔美国人病例呈聚集性，88%的HIV血清学阳性病例呈聚集性。无家可归者中结核病的高发病率是由于HIV阳性者和非白人中的近期传播。非裔美国人和其他非白人可能感染风险高或疾病进展迅速。针对无家可归者的控制措施应包括直接观察治疗和激励措施、对HIV血清学阳性者进行潜伏结核感染治疗以及在酒店和收容所进行筛查。
