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瑞士一州寻求庇护者潜伏性结核感染预防治疗完成率高。

High rate of completion of preventive therapy for latent tuberculosis infection among asylum seekers in a Swiss Canton.

机构信息

University Hospital Geneva, SWITZERLAND;

出版信息

Swiss Med Wkly. 2013 Sep 6;143:w13860. doi: 10.4414/smw.2013.13860. eCollection 2013.

Abstract

BACKGROUND

Preventive treatment may avoid future cases of tuberculosis among asylum seekers. The effectiveness of preventive treatment depends in large part on treatment completion.

METHODS

In a prospective cohort study, asylum seekers of two of the Swiss Canton Vaud migration centres were screened with the Interferon Gamma Release Assay (IGRA). Those with a positive IGRA were referred for medical examination. Individuals with active or past tuberculosis were excluded. Preventive treatment was offered to all participants with positive IGRA but without active tuberculosis. The adherence was assessed during monthly follow-up.

RESULTS

From a population of 393 adult migrants, 98 (24.9%) had a positive IGRA. Eleven did not attend the initial medical assessment. Of the 87 examined, eight presented with pulmonary disease (five of them received a full course of antituberculous therapy), two had a history of prior tuberculosis treatment and two had contraindications to treatment. Preventive treatment was offered to 75 individuals (4 months rifampicin in 74 and 9 months isoniazid in one), of whom 60 (80%) completed the treatment.

CONCLUSIONS

The vulnerability and the volatility of this population make screening and observance of treatment difficult. It seems possible to obtain a high rate of completion using a short course of treatment in a closely monitored population living in stable housing conditions.

摘要

背景

预防治疗可能避免寻求庇护者未来出现结核病病例。预防治疗的效果在很大程度上取决于治疗完成情况。

方法

在一项前瞻性队列研究中,瑞士沃州两个移民中心的寻求庇护者接受了干扰素伽马释放试验(IGRA)筛查。IGRA 阳性者被转介进行医学检查。排除活动性或既往结核病患者。所有 IGRA 阳性但无活动性结核病的参与者均提供预防治疗。在每月的随访中评估依从性。

结果

在 393 名成年移民中,98 人(24.9%)IGRA 阳性。11 人未参加初始医学评估。在 87 名接受检查者中,8 人患有肺部疾病(其中 5 人接受了完整的抗结核治疗),2 人有既往结核病治疗史,2 人有治疗禁忌。向 75 人(4 个月利福平 74 人,1 个月异烟肼 1 人)提供了预防治疗,其中 60 人(80%)完成了治疗。

结论

由于该人群的脆弱性和不稳定性,筛查和治疗观察较为困难。在居住条件稳定的情况下,对处于密切监测下的人群使用短程治疗似乎可以获得较高的完成率。

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