International Reference Laboratory of Mycobacteriology, Statens Serum Institut, 5 Orestads Boulevard, DK-2300 Copenhagen, Denmark.
Tuberculosis (Edinb). 2012 May;92(3):226-31. doi: 10.1016/j.tube.2012.02.001. Epub 2012 Mar 9.
Molecular genotyping studies often focus on clustered tuberculosis and recent transmission. Less attention has been paid to non-clustered tuberculosis. However, non-clustered cases also contribute significantly to the tuberculosis burden, especially in low-incidence countries. The objective of this study is to characterize non-clustered tuberculosis cases in Denmark and point out potential implications for tuberculosis control. The study is based on nationwide IS6110-RFLP genotyping of tuberculosis cases from 1992 through 2004, corresponding to 98% of culture verified cases. Of 3988 cases, 45% were non-clustered. Both Danes and immigrants had a peak incidence of non-clustered tuberculosis at older ages, 80-89 years (4.3 cases/10(5) population/year) and 60-69 years (28.8 cases/10(5) population/year), respectively. In addition, immigrants had a peak at 20-29 years (43.2 cases/10(5) inhabitants/year). In Danes, the incidence of non-clustered tuberculosis decreased during the study period and was predominantly found in elderly persons, presumably reactivating infection acquired during 1910-40, when tuberculosis incidence was high. In immigrants, the incidence was high at all ages, presumably reflecting reactivation of imported infections. In the future, the number of non-clustered tuberculosis cases will decrease, as older Danes die, and as time since primary infection increases for immigrants residing in Denmark. TB control should include focus on non-clustered cases.
分子基因分型研究通常集中在聚集性结核病和近期传播上。对非聚集性结核病的关注较少。然而，非聚集性病例也对结核病负担有重大贡献，尤其是在发病率较低的国家。本研究的目的是描述丹麦的非聚集性结核病病例，并指出对结核病控制的潜在影响。该研究基于 1992 年至 2004 年全国范围内的结核病 IS6110-RFLP 基因分型，涵盖了 98%的培养证实病例。在 3988 例病例中，45%是非聚集性的。丹麦人和移民的非聚集性结核病发病高峰期均为年龄较大的人群，80-89 岁（4.3 例/105 人口/年）和 60-69 岁（28.8 例/105 人口/年）。此外，移民的发病高峰期为 20-29 岁（43.2 例/105 居民/年）。在丹麦，研究期间非聚集性结核病的发病率下降，主要发生在老年人中，可能是重新激活了 1910-1940 年结核病高发期间获得的感染。在移民中，所有年龄段的发病率都很高，可能反映了输入性感染的重新激活。随着老年丹麦人死亡，以及在丹麦居住的移民初次感染时间的延长，未来非聚集性结核病的病例数量将会减少。结核病控制应包括对非聚集性病例的关注。
