Evans Jason T, Smith E Grace, Banerjee Ashis, Smith Robert Mm, Dale James, Innes John A, Hunt David, Tweddell Alan, Wood Annette, Anderson Charlotte, Hewinson R Glyn, Smith Noel H, Hawkey Peter M, Sonnenberg Pam
Regional Centre for Mycobacteriology, West Midlands Public Health Laboratory, Health Protection Agency, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK.
Regional Centre for Mycobacteriology, West Midlands Public Health Laboratory, Health Protection Agency, Birmingham Heartlands Hospital, Birmingham B9 5SS, UK.
Lancet. 2007 Apr 14;369(9569):1270-1276. doi: 10.1016/S0140-6736(07)60598-4.
Despite a recent resurgence in the incidence of bovine tuberculosis in UK cattle herds, no associated rise in the number of cases in man has been noted. Disease due to human Mycobacterium bovis infection usually occurs in older patients, in whom drinking unpasteurised milk in the past is the probable source of infection. Person-to-person transmission is very rare.
After identification of two epidemiologically-linked cases of human M bovis infection through routine laboratory and surveillance activities, all patients identified with M bovis infection in the Midlands from 2001-05 (n=20) were assessed by DNA fingerprinting (MIRU-VNTR and spoligotyping), with additional interviews for patients with a clustered strain.
A cluster of six cases was identified. All clustered cases were young and UK-born; five patients had pulmonary disease, and one patient died due to M bovis meningitis, with four patients possessing factors predisposing to tuberculosis. All patients had common social links through visits to bars in two different areas. With the exception of the first case, there was an absence of zoonotic links or consumption of unpasteurised dairy products, suggesting that person-to-person transmission had occurred.
This report of several instances of M bovis transmission between people in a modern urban setting emphasises the need to maintain control measures for human and bovine tuberculosis. Transmission and subsequent disease was probably due to a combination of host and environmental factors. Prospective surveillance and DNA fingerprinting identified the cluster, enabling health protection teams to set up control measures and prevent further transmission.
尽管英国牛群中牛结核病的发病率最近有所回升，但未发现人间病例数量相应增加。人感染牛分枝杆菌所致疾病通常发生在老年患者中，过去饮用未经巴氏消毒的牛奶可能是其感染源。人传人情况非常罕见。
通过常规实验室和监测活动确定两例流行病学关联的人感染牛分枝杆菌病例后，对2001年至2005年在中部地区确诊感染牛分枝杆菌的所有患者（n = 20）进行了DNA指纹分析（MIRU - VNTR和间隔寡核苷酸分型），并对菌株聚集的患者进行了额外访谈。
确定了一个由六例病例组成的聚集性病例组。所有聚集性病例均为英国出生的年轻人；五例患者患有肺部疾病，一例患者死于牛分枝杆菌脑膜炎，四名患者有易患结核病的因素。所有患者通过前往两个不同地区的酒吧有共同的社会联系。除首例病例外，不存在人畜共患病联系或食用未经巴氏消毒的乳制品，提示发生了人传人情况。
本报告关于现代城市环境中数起人传人感染牛分枝杆菌的情况强调了维持人类和牛结核病控制措施的必要性。传播及后续疾病可能是宿主和环境因素共同作用的结果。前瞻性监测和DNA指纹分析确定了该聚集性病例组，使卫生防护团队能够制定控制措施并防止进一步传播。
