Mammina Caterina, Bonura Celestino, Barchitta Martina, Quattrocchi Annalisa, Palermo Mario, Agodi Antonella
Dipartimento di scienze per la promozione della salute e materno infantile "G. D'Alessandro", Università degli studi di Palermo.
Epidemiol Prev. 2014 Nov-Dec;38(6 Suppl 2):83-7.
To describe the epidemiology of tuberculosis (TB) in Sicily in the years 2010-2013.
Observational study of the TB notifications in the years 2010-2013 by analyzing the Sistema informative delle malattie infettive (SIMI) database and carrying out a molecular epidemiological analysis by spoligo- e 24-loci mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) typing of the Mycobacterium tuberculosis complex (MTBC) isolates identified in Palermo, Italy, in the years 2012-2013.
In the four-year period under study 876 TB cases were notified in Sicily with a mean annual notification rate of 4.4 cases per 100,000 inhabitants. The proportion of TB cases in the foreign-born individuals was increasing and higher than the proportion in Italian-born in the period 2010-2013. The median age of foreign-born patients was significantly lower than the Italian-born (30.5 vs. 51.2 years, p <0,001). Moreover, the distribution by age class was also significantly different, with the largest proportion of TB cases among the foreign-born sub-population in the 15-44 age class, whereas the Italian-born cases were equally distributed in the 15-44, 45-64 and >64 age classes. Eighty-two percent of cases were pulmonary TB. Molecular typing of 151 MTBC isolates identified in Palermo in 2012 and 2013 detected14 lineages and 33 subline ages showing a different distribution among the two patients sub-populations. Only nine MTBC isolates (6.2%) were grouped in four clusters. Two multidrug resistant (MDR) MTBC isolates were identified from an Italian born elderly patient and an Eritrean young patient (Beijing lineage), respectively.
TB epidemiology in Sicily is complex and is rapidly changing. The most striking features are the increasing proportion of cases in the foreign-born population and the wide heterogeneity of MTBC isolates. An integrated approach using both conventional and molecular tools is necessary to accurately assess and monitor TB epidemiology in this Region.
描述2010 - 2013年西西里岛的结核病流行病学情况。
通过分析传染病信息系统（SIMI）数据库对2010 - 2013年的结核病通报进行观察性研究，并对2012 - 2013年在意大利巴勒莫鉴定出的结核分枝杆菌复合群（MTBC）分离株进行寡核苷酸分型和24位点分枝杆菌散布重复单位可变数目串联重复序列（MIRU - VNTR）分型，开展分子流行病学分析。
在研究的四年期间，西西里岛共通报了876例结核病病例，年平均通报率为每10万居民4.4例。2010 - 2013年期间，外国出生个体中的结核病病例比例呈上升趋势，且高于意大利出生个体中的比例。外国出生患者的年龄中位数显著低于意大利出生患者（30.5岁对51.2岁，p<0.001）。此外，年龄组分布也存在显著差异，外国出生亚人群中结核病病例比例最高的年龄段为15 - 44岁，而意大利出生病例在15 - 44岁、45 - 64岁和>64岁年龄组中分布均匀。82%的病例为肺结核。对2012年和2013年在巴勒莫鉴定出的151株MTBC分离株进行分子分型，检测到14个谱系和33个亚谱系，在两个患者亚人群中的分布不同。只有9株MTBC分离株（6.2%）被归为4个簇。分别从一名意大利出生的老年患者和一名厄立特里亚年轻患者（北京谱系）中鉴定出两株耐多药（MDR）MTBC分离株。
西西里岛的结核病流行病学情况复杂且变化迅速。最显著的特征是外国出生人群中病例比例的增加以及MTBC分离株的广泛异质性。需要采用传统和分子工具相结合的综合方法来准确评估和监测该地区的结核病流行病学情况。
