Kuyvenhoven J V, Cobelens F G J
KNCV Tuberculosefonds, Postbus 146, 2501 CC Den Haag.
Ned Tijdschr Geneeskd. 2005 Aug 27;149(35):1925-8.
Recently a large-scale outbreak investigation was held among customers of a supermarket in the Dutch town of Zeist after an employee was diagnosed with smear-positive pulmonary tuberculosis. About 14,000 people had a tuberculin skin test and an additional 6,000 had a chest X-ray. About 400 positive skin tests and 8 cases of active tuberculosis have been reported so far. Investigation of contacts of infectious tuberculosis cases is an important tool in tuberculosis control in low-prevalence countries. It includes chest X-ray examination for active pulmonary tuberculosis after or instead of tuberculin skin testing, and identifying contacts with latent tuberculosis infection followed by preventive treatment. Investigation of household and other close contacts is highly effective. This may not be true for sporadic contacts who are likely to have a low risk of infection, such as in this investigation, where the prevalence of recent infections estimated from reported data is only 3%. The benefits of detecting these cases must be weighed against the costs of such large-scale operations and the probability of false-positive skin test results.
一名员工被诊断为涂片阳性肺结核后，荷兰小镇宰斯特的一家超市对顾客展开了大规模疫情调查。约1.4万人接受了结核菌素皮肤试验，另有6000人进行了胸部X光检查。截至目前，已报告约400例皮肤试验呈阳性以及8例活动性肺结核病例。在结核病低流行国家，对传染性肺结核病例的接触者进行调查是结核病控制的一项重要手段。这包括在结核菌素皮肤试验之后或替代该试验，对活动性肺结核进行胸部X光检查，并识别潜伏性结核感染的接触者，随后进行预防性治疗。对家庭及其他密切接触者的调查非常有效。对于散在接触者而言可能并非如此，比如在此次调查中，散在接触者的感染风险可能较低，根据报告数据估算，近期感染率仅为3%。检测这些病例的益处必须与如此大规模行动的成本以及皮肤试验结果假阳性的可能性相权衡。
