Klovdahl A S, Graviss E A, Yaganehdoost A, Ross M W, Wanger A, Adams G J, Musser J M
Department of Sociology, The Faculties, Australian National University, Canberra.
Soc Sci Med. 2001 Mar;52(5):681-94. doi: 10.1016/s0277-9536(00)00170-2.
After decades of decline in developed countries, there was a resurgence of tuberculosis in the mid-1980s accompanied by increased recognition that this infectious disease has long remained a major public health problem at the global level. New methods from molecular biology, in particular DNA 'fingerprinting' (of Mycobacterium tuberculosis), made it clear that current transmission and recent infection (in contrast to reactivation of earlier, latent infection) were much more significant than previously believed. Studies of tuberculosis outbreaks using these new tools pointed to complex networks through which infection was spreading and highlighted the need for new approaches to outbreak investigation and disease control. In the study reported here a new approach--combining methods from molecular biology, epidemiology and network analysis--was used to examine an outbreak of tuberculosis in Houston, Texas. Initial investigation using conventional strategies revealed few contacts among 37 patients with identical (six-band) DNA (IS6110-based) fingerprints but subsequent research uncovered over 40 places (including many gay bars) to which patients in this outbreak could be linked. Network methods were used to reconstruct an outbreak network and to quantify the relative importance (here, 'betweenness' centrality) of different actors (persons and places) playing a role in the outbreak. The multidisciplinary work provides the basis for a new approach to outbreak investigation and disease control.
在发达国家经历了数十年的结核病发病率下降之后，20世纪80年代中期结核病出现了再度流行，同时人们越来越认识到这种传染病长期以来一直是全球层面的一个主要公共卫生问题。分子生物学的新方法，特别是（结核分枝杆菌的）DNA“指纹识别”，清楚地表明当前的传播和近期感染（与早期潜伏感染的再激活不同）比以前认为的要重要得多。利用这些新工具对结核病暴发进行的研究指出了感染传播所通过的复杂网络，并突出了对暴发调查和疾病控制新方法的需求。在本文报道的研究中，一种结合了分子生物学、流行病学和网络分析方法的新方法被用于研究得克萨斯州休斯敦的一次结核病暴发。最初使用传统策略进行的调查显示，37名具有相同（六带）DNA（基于IS6110）指纹的患者之间几乎没有接触，但随后的研究发现了40多个与此次暴发患者有关联的场所（包括许多同性恋酒吧）。网络方法被用于重建暴发网络，并量化在暴发中发挥作用的不同行为者（人和场所）的相对重要性（这里是“中介中心性”）。这项多学科工作为暴发调查和疾病控制的新方法提供了基础。
