Health Protection Agency, Yorkshire and the Humber, Leeds, United Kingdom.
Euro Surveill. 2012 Sep 20;17(38):20278.
Tuberculosis (TB) patients who do not complete treatment pose a potential public health risk. In West Yorkshire, local clinicians suspected that this risk was overestimated by the national Enhanced Tuberculosis Surveillance system. We audited patients who failed to complete treatment and were categorised as lost-to-follow-up (LTFU) between 2004 and 2008, using a combination of hand searching existing records and obtaining additional information from clinicians. In the study period 2,031 TB cases with reported outcome were notified in West Yorkshire, 23% (n=474) did not complete treatment, and 199 (42%) of those were categorised as LTFU 12 months after notification. Of these 199, 49% (n=98) remained LTFU after the audit, 51% (n=101) were re-classified to the following categories: 24% (n=47) transferred abroad, 16% (n=31) recommenced and completed treatment, 6% (n=13) transferred to another clinic in the United Kingdom (UK), and 5% (n=10) died. These patients therefore no-longer posed a public health risk. Further training for clinicians to improve accuracy of outcome reporting has been initiated. Nationally, the collection of treatment outcome data needs to be strengthened and extending the follow-up for treatment outcome monitoring should be considered.
未完成治疗的结核病（TB）患者构成潜在的公共卫生风险。在西约克郡，当地临床医生怀疑全国强化结核病监测系统高估了这种风险。我们使用手动搜索现有记录和从临床医生处获取额外信息的组合，对 2004 年至 2008 年间未能完成治疗且被归类为失访（LTFU）的患者进行了审核。在研究期间，西约克郡报告了 2031 例结核病病例，其中 23%（n=474）未完成治疗，其中 199 例（42%）在通知后 12 个月被归类为 LTFU。在这 199 例中，49%（n=98）在审核后仍为 LTFU，51%（n=101）重新分类为以下类别：24%（n=47）转移到国外，16%（n=31）重新开始并完成治疗，6%（n=13）转移到英国（UK）的另一个诊所，5%（n=10）死亡。因此，这些患者不再构成公共卫生风险。已启动对临床医生的进一步培训，以提高结果报告的准确性。在全国范围内，需要加强治疗结果数据的收集，并应考虑延长治疗结果监测的随访时间。
