Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, Department of Medicine, University of Cape Town.
S Afr Med J. 2009 Oct;99(10):738-43.
Tuberculosis (TB) remains a leading cause of mortality and morbidity in South Africa. While adult TB results from both recent and past infection, childhood TB results from recent infection and reflects ongoing transmission despite current TB control strategies.
A South African community with high rates of TB and HIV disease.
A Geographic Information System was used to spatially and temporally define the relationships between TB exposure, infection and disease in children < 15 years of age with exposure to adult HIV-positive and HIV-negative TB disease on residential plots between 1997 and 2007.
During the study period the annual adult TB notification rate increased from 629 to 2 106/100 000 and the rate in children aged < 15 years ranged between 664/100 000 and 1 044/100 000. The mean number of exposures to adult TB for TB-uninfected children, latently TB-infected children and TB cases were 5.1%, 5.4% and 33% per annum and the mean number of adult smear-positive cases per exposed child was 1.0, 1.6 and 1.9, respectively. Acquisition of TB infection was not associated with HIV status of the adult TB case to which the child was exposed, and 36% of child TB cases were diagnosed before the temporally closest adult case on their plot.
Childhood infection and disease were quantitatively linked to infectious adult TB prevalence in an immediate social network. Childhood infection should be monitored in high-burden settings as a marker of ongoing TB transmission. Improved knowledge of township childhood and adult social networks could also facilitate targeted active case finding, which may provide an adjunct to currently failing TB control strategies.
结核病（TB）仍然是南非死亡和发病的主要原因。成人结核病是由近期和既往感染引起的，而儿童结核病是由近期感染引起的，反映了尽管目前采取了结核病控制策略，但仍在持续传播。
南非一个结核病和艾滋病毒病发病率高的社区。
利用地理信息系统，在 1997 年至 2007 年间，在居住地段上，对接触成人 HIV 阳性和 HIV 阴性结核病的 15 岁以下儿童的 TB 暴露、感染和疾病，进行时空定义。
在研究期间，每年成人结核病报告率从 629 例/10 万增加到 2106 例/10 万，而 15 岁以下儿童的发病率在 664/10 万至 1044/10 万之间。TB 未感染者、潜伏性 TB 感染者和 TB 病例的儿童平均每年接触成人 TB 的次数分别为 5.1%、5.4%和 33%，每例暴露儿童的成人涂片阳性病例数分别为 1.0、1.6 和 1.9。儿童 TB 病例的获得与接触儿童的成人 TB 病例的 HIV 状态无关，36%的儿童 TB 病例在其居住地段上的最近成人病例之前被诊断出来。
儿童感染和疾病与直接社会网络中传染性成人结核病流行程度存在定量关系。在高负担地区应监测儿童感染情况，作为持续结核病传播的指标。提高对城镇儿童和成人社会网络的了解，也可以促进有针对性的主动病例发现，这可能是目前结核病控制策略的补充。
