Laboratoire de Bactériologie-Hygiène, Université Pierre et Marie Curie, Paris, France.
Int J Tuberc Lung Dis. 2012 May;16(5):649-55. doi: 10.5588/ijtld.11.0241. Epub 2012 Mar 8.
To evaluate the impact of an active case-finding programme on tuberculosis (TB) transmission in homeless shelters in Paris, France.
Between 1994 and 1997, an active case-finding programme was implemented in homeless shelters using a mobile radiological screening unit, and continued from 1997 to 2007. During these periods, the strains isolated from TB cases diagnosed in the homeless were genotyped by restriction fragment length polymorphism analysis using the insertion sequence IS6110 as a probe.
Between 1994 and 2007, 313 new TB cases were diagnosed among the homeless population: 179 through the programme among shelter users, and 134 among homeless people not using shelters. Half of the strains were clustered in 35 distinct patterns (2-48 cases/cluster). The clustering of TB cases steadily decreased in shelters during the 13 years of the survey, from 14.3 to 2.7 related cases per year (P < 0.01) and from 75% to 30% of related cases among all TB cases (P < 0.01). In contrast, there was only a slight trend towards a decrease in homeless people not using shelters.
Active case finding in homeless shelters resulted in a decrease in case clustering, mainly in shelter users. Genotyping contributed to confirming the positive impact of the intervention.
评估在法国巴黎的无家可归者收容所中开展主动病例发现计划对结核病（TB）传播的影响。
1994 年至 1997 年间，在无家可归者收容所中使用移动放射筛查单位实施了主动病例发现计划，并从 1997 年持续到 2007 年。在此期间，使用插入序列 IS6110 作为探针，通过限制片段长度多态性分析对在无家可归者中诊断出的结核病例分离株进行基因分型。
1994 年至 2007 年间，在无家可归者人群中诊断出 313 例新的结核病例：179 例通过收容所使用者中的计划发现，134 例通过未使用收容所的无家可归者发现。一半的菌株聚类成 35 个不同的模式（2-48 例/聚类）。在调查的 13 年中，收容所中结核病例的聚类稳步下降，从每年 14.3 例相关病例降至 2.7 例（P<0.01），从所有结核病例中 75%的相关病例降至 30%（P<0.01）。相比之下，未使用收容所的无家可归者中仅呈轻微下降趋势。
在无家可归者收容所中开展主动病例发现导致病例聚类减少，主要是在收容所使用者中。基因分型有助于证实干预的积极影响。
