Thanh Thuy Hoang Thi, Ngoc Sy Dinh, Viet Nhung Nguyen, Van Hung Nguyen, Horby Peter, Cobelens Frank G J, Wertheim Heiman F L
National Tuberculosis Control Programme of Vietnam, National Lung Hospital (VNTP-NLH), Hanoi, Vietnam.
BMC Public Health. 2014 Jul 11;14:713. doi: 10.1186/1471-2458-14-713.
Close contacts of tuberculosis (TB) patients are at increased risk of developing tuberculosis. Although passive contact screening guidelines are incorporated in the national TB control program, currently it is unknown how frequent close contacts are screened for TB in Vietnam. This study assesses current contact screening practices in Vietnam and determines the proportion of household contacts screened of newly registered TB patients.
Survey of household contacts of smear-positive TB patients (index patients) registered for treatment in 2008 in three Vietnamese cities. Households were interviewed in 2010 about screening for TB since treatment registration date of the index patient.
We interviewed 4,118 household contacts of 1,091 identified index cases. Contact screening mainly relied on self-referral by household contacts. Of the 4,118 household contacts, 474 (11.5%) self-referred for TB screening, while this screening proportion was only 5.5% among contacts under 5 years old (16/293). Sputum examinations were performed in 374 (78.9%) of the screened contacts. Contact screening identified 27 cases of pulmonary TB (0.7%; or 656 cases/100,000 contacts), of which 20 were detected by sputum smear.
The low proportion of household TB contacts screened for TB illustrates the limitations of passive contact screening as currently practiced in Vietnam. Children under 5 years of age are particularly neglected with this approach. Active contact screening with fixed follow-up times of close contacts of newly diagnosed TB patients should be considered in Vietnam, particularly in case of young children and drug-resistant TB.
结核病（TB）患者的密切接触者患结核病的风险增加。尽管国家结核病控制规划纳入了被动接触者筛查指南，但目前越南对密切接触者进行结核病筛查的频率尚不清楚。本研究评估了越南目前的接触者筛查做法，并确定了新登记结核病患者的家庭接触者接受筛查的比例。
对2008年在越南三个城市登记接受治疗的涂片阳性结核病患者（索引患者）的家庭接触者进行调查。2010年对这些家庭就自索引患者治疗登记日期以来的结核病筛查情况进行了访谈。
我们对1091例已识别索引病例的4118名家庭接触者进行了访谈。接触者筛查主要依靠家庭接触者的自我推荐。在4118名家庭接触者中，474人（11.5%）自我推荐进行结核病筛查，而在5岁以下的接触者中这一筛查比例仅为5.5%（16/293）。在374名（78.9%）接受筛查的接触者中进行了痰检。接触者筛查发现了27例肺结核病例（0.7%；或每100,000名接触者中有656例），其中20例通过痰涂片检测出。
接受结核病筛查的家庭接触者比例较低，这说明了越南目前实施的被动接触者筛查存在局限性。这种方法尤其忽视了5岁以下的儿童。越南应考虑对新诊断结核病患者的密切接触者进行固定随访时间的主动接触者筛查，特别是对于幼儿和耐多药结核病患者。
