Woolcock Institute of Medical Research, University of Sydney, Glebe, Sydney 2037, Australia.
Eur Respir J. 2013 Jan;41(1):140-56. doi: 10.1183/09031936.00070812. Epub 2012 Aug 30.
Investigation of contacts of patients with tuberculosis (TB) is a priority for TB control in high-income countries, and is increasingly being considered in resource-limited settings. This review was commissioned for a World Health Organization Expert Panel to develop global contact investigation guidelines. We performed a systematic review and meta-analysis of all studies reporting the prevalence of TB and latent TB infection, and the annual incidence of TB among contacts of patients with TB. After screening 9,555 titles, we included 203 published studies. In 95 studies from low- and middle-income settings, the prevalence of active TB in all contacts was 3.1% (95% CI 2.2-4.4%, I(2)=99.4%), microbiologically proven TB was 1.2% (95% CI 0.9-1.8%, I(2)=95.9%), and latent TB infection was 51.5% (95% CI 47.1-55.8%, I(2)=98.9%). The prevalence of TB among household contacts was 3.1% (95% CI 2.1-4.5%, I(2)=98.8%) and among contacts of patients with multidrug-resistant or extensively drug-resistant TB was 3.4% (95% CI 0.8-12.6%, I(2)=95.7%). Incidence was greatest in the first year after exposure. In 108 studies from high-income settings, the prevalence of TB among contacts was 1.4% (95% CI 1.1-1.8%, I(2)=98.7%), and the prevalence of latent infection was 28.1% (95% CI 24.2-32.4%, I(2)=99.5%). There was substantial heterogeneity among published studies. Contacts of TB patients are a high-risk group for developing TB, particularly within the first year. Children <5 yrs of age and people living with HIV are particularly at risk. Policy recommendations must consider evidence of the cost-effectiveness of various contact tracing strategies, and also incorporate complementary strategies to enhance case finding.
对结核病（TB）患者的接触者进行调查是高收入国家结核病控制的优先事项，在资源有限的环境中也越来越受到重视。这项审查是为世界卫生组织专家小组委托进行的，目的是制定全球接触者调查指南。我们对所有报告结核病和潜伏性结核病感染患病率以及结核病患者接触者中结核病年发病率的研究进行了系统评价和荟萃分析。在筛选了 9555 个标题后，我们纳入了 203 项已发表的研究。在来自中低收入环境的 95 项研究中，所有接触者中活动性结核病的患病率为 3.1%（95%CI 2.2-4.4%，I²=99.4%），经微生物证实的结核病为 1.2%（95%CI 0.9-1.8%，I²=95.9%），潜伏性结核病感染为 51.5%（95%CI 47.1-55.8%，I²=98.9%）。家庭接触者中结核病的患病率为 3.1%（95%CI 2.1-4.5%，I²=98.8%），耐多药或广泛耐药结核病患者接触者中结核病的患病率为 3.4%（95%CI 0.8-12.6%，I²=95.7%）。发病风险在接触后第一年最高。在来自高收入环境的 108 项研究中，接触者中结核病的患病率为 1.4%（95%CI 1.1-1.8%，I²=98.7%），潜伏性感染的患病率为 28.1%（95%CI 24.2-32.4%，I²=99.5%）。发表的研究之间存在很大的异质性。结核病患者的接触者是发生结核病的高风险群体，尤其是在接触后的第一年。5 岁以下儿童和艾滋病毒感染者尤其处于危险之中。政策建议必须考虑各种接触者追踪策略的成本效益证据，同时还必须纳入补充策略以加强病例发现。
