Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.
PLoS One. 2012;7(11):e49880. doi: 10.1371/journal.pone.0049880. Epub 2012 Nov 15.
Existing tuberculosis control strategies in Vietnam are based on symptomatic patients attending health services for investigation. This approach has not resulted in substantial reductions in the prevalence of tuberculosis disease, despite the National Tuberculosis Program achieving high treatment completion rates. Alternative approaches are being considered.
To determine the feasibility and yield of contact investigation in households of patients with smear positive pulmonary tuberculosis among household members of tuberculosis patients in Hanoi, Vietnam.
Household contacts of patients with smear positive pulmonary tuberculosis were recruited at four urban and rural District Tuberculosis Units in Hanoi. Clinical and radiological screening was conducted at baseline, six months and 12 months. Sputum microscopy and culture was performed in contacts suspected of having tuberculosis. MIRU-VNTR molecular testing was used to compare the strains of patients and their contacts with disease.
Among 545 household contacts of 212 patients, four were diagnosed with tuberculosis at baseline (prevalence 734 cases per 100,000 persons, 95% CI 17-1451) and one was diagnosed with tuberculosis during the subsequent 12 months after initial screening (incidence 180 cases per 100,000 person-years, 95% CI 44-131). Two of these cases were culture positive for M. tuberculosis and both had identical or near-identical MIRU-VNTR strain types.
Household contacts of patients with potentially infectious forms of tuberculosis have a high prevalence of disease. Household contact investigation is feasible in Vietnam. Further research is required to investigate its effectiveness.
越南现有的结核病控制策略基于有症状的患者到卫生服务机构进行检查。尽管国家结核病规划实现了高治疗完成率，但这种方法并没有使结核病的流行率显著降低。目前正在考虑替代方法。
确定在越南河内的肺结核患者家庭中，对涂阳肺结核患者的家庭接触者进行接触调查的可行性和效果。
在河内的四个城市和农村区结核病单位招募涂阳肺结核患者的家庭接触者。在基线、六个月和十二个月时进行临床和放射学筛查。对疑似患有结核病的接触者进行痰显微镜检查和培养。使用 MIRU-VNTR 分子检测比较患者及其接触者的菌株。
在 212 名患者的 545 名家庭接触者中，有 4 人在基线时被诊断患有结核病（患病率为每 10 万人 734 例，95%置信区间为 17-1451），有 1 人在初次筛查后的 12 个月内被诊断患有结核病（发病率为每 10 万人 180 例，95%置信区间为 44-131）。其中 2 例培养出结核分枝杆菌阳性，且两者的 MIRU-VNTR 株型相同或几乎相同。
具有潜在传染性形式的肺结核患者的家庭接触者疾病患病率很高。家庭接触者调查在越南是可行的。需要进一步研究以调查其效果。
