Tuberculosis Program Evaluation and Research Unit, University of Alberta, Edmonton, AB.
Can J Public Health. 2010 May-Jun;101(3):205-9. doi: 10.1007/BF03404391.
A context-specific, spatial-temporal understanding of a chain of tuberculosis (TB) transmission can inform TB elimination strategy.
Clinical, public health and molecular epidemiologic data were used to: 1) identify and describe a complex cluster of TB cases in Alberta, 2) elucidate transmission sequences, and 3) assess case-patient mobility. Socio-economic indicators in loci of transmission and the province at large were described. Factors seen to be fostering or hampering TB elimination were identified.
Over a 15-year period, 18 TB cases in Alberta and multiple cases in the Northwest Territories were determined to be due to the same strain. One patient was diagnosed at death; all others completed directly-observed therapy (DOT). Case-level analysis revealed that patients were highly mobile with transmission of the strain over 26,569 km2, an average of 2.8 different places of residence per patient during treatment, and contacts of sputum smear-positive cases spanning 9 of 17 regional health authorities. The majority of the contacts (57%) were attached to a single infectious case living in a homeless shelter. The three loci of transmission in Alberta were separated geographically but similar in terms of median incomes, rates of unemployment, levels of post-secondary education, and rates of population mobility (p < 0.0001).
Upon review of the experience, central oversight, intra- and inter-jurisdictional coordination and DOT were seen as fostering, and the absence of 'real-time' DNA fingerprinting, social network analysis, engineering controls in shelters and better determinants of health in loci of transmission were seen as hampering TB elimination.
对结核病（TB）传播链进行特定于上下文和时空的理解，可以为结核病消除策略提供信息。
临床、公共卫生和分子流行病学数据用于：1）识别和描述艾伯塔省的一个复杂结核病病例集群，2）阐明传播序列，3）评估病例患者的流动性。描述了传播点和全省的社会经济指标。确定了促进或阻碍结核病消除的因素。
在 15 年期间，艾伯塔省的 18 例结核病病例和西北地区的多例病例被确定为同一菌株所致。一名患者死亡时被诊断出患有结核病；所有其他患者均完成了直接观察治疗（DOT）。病例水平分析显示，患者高度流动，该菌株传播范围达 26,569 平方公里，治疗期间每位患者平均有 2.8 个不同的居住地，痰涂片阳性病例的接触者遍布 17 个区域卫生当局中的 9 个。接触者中大多数（57%）与居住在收容所的单一传染性病例有关。艾伯塔省的三个传播点在地理位置上是分开的，但在收入中位数、失业率、高等教育水平和人口流动性方面相似（p < 0.0001）。
审查经验后，中央监督、州内和州际协调以及 DOT 被认为是促进因素，而缺乏“实时”DNA 指纹分析、社会网络分析、收容所中的工程控制以及传播点的健康更好决定因素被认为是阻碍结核病消除的因素。
