Division of Tuberculosis Elimination, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta,Georgia, USA.
Am J Respir Crit Care Med. 2012 Aug 1;186(3):273-9. doi: 10.1164/rccm.201111-2076OC. Epub 2012 May 3.
From 1993 to 2010, annual U.S. tuberculosis (TB) rates declined by 58%. However, this decline has slowed and disproportionately occurred among U.S.-born (78%) versus foreign-born persons (47%). Addressing the high burden of latent TB infection (LTBI) must be prioritized.
Only Tennessee has implemented a statewide program for finding and treating people with LTBI. The program was designed to address high statewide TB rates and growing burden among the foreign-born. We sought to assess the feasibility and yield of Tennessee's program.
Analyzing data from the 4.8-year period from program inception in March 2002 through December 2006, we quantified patients screened using a TB risk assessment tool, tuberculin skin tests (TST) placed and read, TST results, and patients initiating and completing LTBI treatment. We then estimated the number needed to screen to find and treat one person with LTBI and to prevent one case of TB.
Of 168,517 persons screened, 102,709 had a TST placed and read. Among 9,090 (9%) with a positive TST result, 53% initiated treatment, 54% of whom completed treatment. An estimated 195 TB cases were prevented over the 4.8 years analyzed, and program performance measures improved annually. The number of TSTs placed to prevent one TB case ranged from 150 for foreign-born persons to 9,834 for persons without TB risk.
Targeted tuberculin testing and LTBI treatment is feasible and likely to reduce TB rates over time. Yield and cost-effectiveness are maximized by prioritizing foreign-born persons, a large population with high TB risk.
从 1993 年到 2010 年，美国的结核病（TB）发病率每年下降 58%。然而，这一下降速度已经放缓，而且不成比例地发生在美国出生的人（78%）和外国出生的人（47%）之间。必须优先解决潜伏性结核感染（LTBI）的高负担问题。
只有田纳西州实施了全州范围内的发现和治疗 LTBI 患者的计划。该计划旨在解决全州范围内的高结核病发病率和外国出生人群中不断增加的负担。我们试图评估田纳西州计划的可行性和效果。
通过分析从 2002 年 3 月项目启动到 2006 年 12 月的 4.8 年期间的数据，我们量化了使用结核病风险评估工具进行筛查的患者数量、放置和读取的结核菌素皮肤试验（TST）、TST 结果以及开始和完成 LTBI 治疗的患者数量。然后，我们估计了筛查发现和治疗一名 LTBI 患者以及预防一例结核病所需的人数。
在接受筛查的 168517 人中，有 102709 人进行了 TST 检测。在 9090 名（9%）TST 阳性的人中，有 53%开始接受治疗，其中 54%完成了治疗。在分析的 4.8 年中，估计预防了 195 例结核病病例，并且计划的绩效指标逐年提高。放置 TST 以预防一例结核病的人数范围从外国出生者的 150 人到无结核病风险者的 9834 人。
针对潜伏性结核感染进行结核菌素检测和治疗是可行的，并且随着时间的推移可能会降低结核病发病率。通过优先考虑外国出生的人群（一个具有高结核病风险的庞大人群），可以最大限度地提高效果和成本效益。
