Reichler Mary R, Reves Randall, Bur Sarah, Thompson Virginia, Mangura Bonita T, Ford Josie, Valway Sarah E, Onorato Ida M
Mailstop E-10, DTBE, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA.
JAMA. 2002 Feb 27;287(8):991-5. doi: 10.1001/jama.287.8.991.
Contact investigations are routinely conducted by health departments throughout the United States for all cases of active pulmonary tuberculosis (TB) to identify secondary cases of active TB and latent TB infection and to initiate therapy as needed in these contacts. Little is known about the actual procedures followed, or the results.
To evaluate contact investigations conducted by US health departments and the outcomes of these investigations.
DESIGN, SETTING, AND SUBJECTS: Review of health department records for all contacts of 349 patients with culture-positive pulmonary TB aged 15 years or older reported from 5 study areas in the United States during 1996.
Number of contacts identified, fully screened, and infected per TB patient; rates of TB infection and disease among contacts of TB patients; and type and completeness of data collected during contact investigations.
A total of 3824 contacts were identified for 349 patients with active pulmonary TB. Of the TB patients, 45 (13%) had no contacts identified. Of the contacts, 55% completed screening, 27% had an initial but no postexposure tuberculin skin test, 12% were not screened, and 6% had a history of prior TB or prior positive tuberculin skin test. Of 2095 contacts who completed screening, 68% had negative skin test results, 24% had initial positive results with no prior test result available, 7% had documented skin test conversions, and 1% had active TB at the time of investigation. Close contacts younger than 15 years (76% screened vs 65% for older age groups; P<.001) or exposed to a TB patient with a positive smear (74% screened vs 59% for those with a negative smear; P<.001) were more likely to be fully screened. Close contacts exposed to TB patients with both a positive smear and a cavitary chest radiograph were more likely to have TB infection or disease (62% vs 33% for positive smear only vs 44% for cavitary radiograph only vs 37% for neither characteristic; P<.001). A number of factors associated with TB patient infectiousness, contact susceptibility to infection, contact risk of progression to active TB, and amount of contact exposure to the TB patient were not routinely recorded in health department records.
Improvement is needed in the complex, multistep process of contact investigations to ensure that contacts of patients with active pulmonary TB are identified and appropriately screened.
美国各地的卫生部门针对所有活动性肺结核（TB）病例定期开展接触者调查，以识别活动性肺结核的二代病例和潜伏性结核感染，并在这些接触者需要时启动治疗。对于实际遵循的程序或结果，人们了解甚少。
评估美国卫生部门开展的接触者调查及其调查结果。
设计、地点和研究对象：回顾1996年美国5个研究地区报告的349例年龄在15岁及以上的痰培养阳性肺结核患者所有接触者的卫生部门记录。
每名肺结核患者识别出的、接受全面筛查的和受感染的接触者数量；肺结核患者接触者中的结核感染率和发病率；接触者调查期间收集的数据类型和完整性。
349例活动性肺结核患者共识别出3824名接触者。在这些肺结核患者中，45例（13%）未识别出接触者。在接触者中，55%完成了筛查，27%进行了初次结核菌素皮肤试验但未进行接触后试验，12%未接受筛查，6%有既往肺结核病史或既往结核菌素皮肤试验阳性史。在2095名完成筛查的接触者中，68%皮肤试验结果为阴性，24%初次结果为阳性且无既往试验结果，7%有记录的皮肤试验结果转换，1%在调查时患有活动性肺结核。15岁以下的密切接触者（76%接受了筛查，而年龄较大组为65%；P<0.001）或接触涂片阳性肺结核患者的密切接触者（74%接受了筛查，而涂片阴性者为59%；P<0.001）更有可能接受全面筛查。接触涂片和胸部X光片有空洞的肺结核患者的密切接触者更有可能感染结核或患结核病（涂片阳性者为62%，仅涂片阳性者为33%，仅X光片有空洞者为44%，两者均无特征者为37%；P<0.001）。一些与肺结核患者传染性、接触者感染易感性、接触者进展为活动性肺结核的风险以及接触者与肺结核患者接触程度相关的因素，卫生部门记录中未常规记录。
接触者调查这一复杂的多步骤过程需要改进，以确保识别出活动性肺结核患者的接触者并对其进行适当筛查。
