Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Lancet Infect Dis. 2013 Sep;13(9):777-84. doi: 10.1016/S1473-3099(13)70128-2. Epub 2013 Jun 5.
Multidrug-resistant (MDR) tuberculosis is a potential threat to tuberculosis elimination, but the extent of MDR tuberculosis disease in the USA that is attributable to transmission within the country is unknown. We assessed transmission of MDR tuberculosis and potential contributing factors in the USA.
In a cross-sectional study, clinical, demographic, epidemiological, and Mycobacterium tuberculosis genotype data were obtained during routine surveillance of all verified cases of MDR tuberculosis reported from eight states in the USA (California from Jan 1, 2007, to Dec 31, 2009; Texas from Jan 1, 2007, to March 31, 2009; and the states of Colorado, Maryland, Massachusetts, New York, Tennessee, and Washington from Jan 1, 2007 to Dec 31, 2008). In-depth interviews and health-record abstraction were done for all who consented to ascertain potential interpersonal connections.
168 cases of MDR tuberculosis were reported in the eight states during our study period. 92 individuals (55%) consented to in-depth interview. 20 (22%) of these individuals developed MDR tuberculosis as a result of transmission in the USA; a source case was identified for eight of them (9%). 20 individuals (22%) had imported active tuberculosis (ie, culture-confirmed disease within 3 months of entry into the USA). 38 (41%) were deemed to have reactivation of disease, of whom 14 (15%) had a known previous episode of tuberculosis outside the USA. Five individuals (5%) had documented treatment of a previous episode in the USA, and so were deemed to have relapsed. For nine cases (10%), insufficient evidence was available to definitively classify reason for presentation.
About a fifth of cases of MDR tuberculosis in the USA can be linked to transmission within the country. Many individuals acquire MDR tuberculosis before entry into the USA. MDR tuberculosis needs to be diagnosed rapidly to reduce potential infectious periods, and clinicians should consider latent tuberculosis infection treatment-tailored to the results of drug susceptibility testing of the putative source case-for exposed individuals.
Centers for Disease Control and Prevention.
耐多药结核病（MDR-TB）是结核病消除的潜在威胁，但美国境内 MDR-TB 疾病的范围及其在国内传播的程度尚不清楚。我们评估了美国 MDR-TB 的传播情况及其潜在的促成因素。
在一项横断面研究中，我们从美国八个州常规监测报告的所有 MDR-TB 确诊病例中获取临床、人口统计学、流行病学和分枝杆菌结核基因型数据，这些州包括加利福尼亚州（2007 年 1 月 1 日至 2009 年 12 月 31 日）、德克萨斯州（2007 年 1 月 1 日至 2009 年 3 月 31 日）和科罗拉多州、马里兰州、马萨诸塞州、纽约州、田纳西州和华盛顿州（2007 年 1 月 1 日至 2008 年 12 月 31 日）。我们对所有同意接受深入访谈以确定潜在人际联系的人进行了深入访谈和健康记录摘要。
在我们的研究期间，美国八个州共报告了 168 例 MDR-TB 病例。92 名个人（55%）同意接受深入访谈。其中 20 人（22%）因在美国发生传播而患 MDR-TB；其中 8 人（9%）确定了源病例。20 人（22%）患有输入性活动性肺结核（即，进入美国后 3 个月内经培养确诊的疾病）。38 人（41%）被认为是疾病再激活，其中 14 人（15%）有既往在美国以外发生的结核病病史。5 人（5%）在美国有记录的先前发病治疗，因此被认为是复发。对于 9 例（10%）病例，没有足够的证据来明确分类发病原因。
美国约五分之一的 MDR-TB 病例可归因于国内传播。许多人在进入美国之前就感染了 MDR-TB。为了减少潜在的传染期，需要迅速诊断 MDR-TB，临床医生应该考虑针对疑似源病例的药敏试验结果，为接触者量身定制潜伏性结核感染治疗。
美国疾病控制与预防中心。
