Leung Chi Chiu, Yew Wing Wai, Chang Kwok Chiu, Tam Cheuk Ming, Chan Chi Kuen, Law Wing Sze, Wong Man Yee, Lee Shuk Nor, Leung Maria
Tuberculosis and Chest Service, Department of Health, Hong Kong.
Arch Pediatr Adolesc Med. 2006 Mar;160(3):247-51. doi: 10.1001/archpedi.160.3.247.
To estimate the risk of active tuberculosis (TB) and its implication on preventive treatment among BCG-vaccinated schoolchildren.
Cohort and case-control designs.
Community settings in a high-prevalence area.
Children in primary school. The main exposure was their tuberculin response.
Of 94,928 primary schoolchildren tuberculin tested during a routine school revaccination program in 1999, 656 with a tuberculin response at 20 mm or more were followed up prospectively through the territory-wide TB registry up to December 31, 2003, for the development of TB. In a separate case-control analysis, the tuberculin responses of children who subsequently had active TB (at the age of 10-15 years) were compared with those of their sex- and age-matched classmates to ascertain the relative risks of TB for different tuberculin reaction categories. The absolute and relative risks were applied to the 1999 cohort for estimating the incidence of TB among different tuberculin reactors.
The annual incidence (95% confidence interval) of active TB was estimated to be 13.4 (5.6-40.6) per 100,000 for the entire cohort and 7.5 (2.4-24.5), 7.5 (1.7-32.0), 16.0 (4.4-57.2), 92.6 (26.6-320.2), and 340.6 (163.3-626.4) per 100,000 for children with a tuberculin reaction at 0 to 4, 5 to 9, 10 to 14, 15 to 19, and 20 mm or more, respectively. By using 10 mm as the cutoff, 482 (95% confidence interval, 163-1391) children have to be treated to prevent a single case of active TB within 5 years. Treatment will cover 17.5% of the cohort, but prevent only 54.1% of all active TB cases.
It is desirable to reexamine the existing screening method for BCG-vaccinated children from high-prevalence countries.
评估接种卡介苗的学童患活动性结核病（TB）的风险及其对预防性治疗的意义。
队列研究和病例对照研究设计。
高流行地区的社区环境。
小学生。主要暴露因素是他们的结核菌素反应。
在1999年的一次常规学校复种疫苗计划中，对94,928名小学生进行了结核菌素检测，其中656名结核菌素反应为20毫米或以上的学生通过全地区结核病登记系统进行前瞻性随访，直至2003年12月31日，观察结核病的发生情况。在一项单独的病例对照分析中，将随后患活动性结核病（年龄在10至15岁）的儿童的结核菌素反应与其性别和年龄匹配的同学进行比较，以确定不同结核菌素反应类别患结核病的相对风险。将绝对风险和相对风险应用于1999年队列，以估计不同结核菌素反应者中结核病的发病率。
整个队列中活动性结核病的年发病率（95%置信区间）估计为每10万人中13.4（5.6 - 40.6）例，结核菌素反应在0至4、5至9、1至4、15至19以及20毫米或以上的儿童中，每10万人中的发病率分别为7.5（2.4 - 24.5）、7.5（1.7 - 32.0）、16.0（4.4 - 57.2）、92.6（26.6 - 320.2）和340.6（163.3 - 626.4）例。以10毫米为临界值，必须治疗482名（95%置信区间，163 - 1391）儿童，才能在5年内预防1例活动性结核病。治疗将覆盖队列的17.5%，但只能预防所有活动性结核病例的54.1%。
有必要重新审视高流行国家接种卡介苗儿童的现有筛查方法。
