Patel Smit, Paulsen Catherine, Heffernan Courtney, Saunders Duncan, Sharma Meenu, King Malcolm, Hoeppner Vernon, Orr Pamela, Kunimoto Dennis, Menzies Dick, Christianson Sara, Wolfe Joyce, Boffa Jody, McMullin Kathleen, Lopez-Hille Carmen, Senthilselvan Ambikaipakan, Long Richard
Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
PLoS One. 2017 Nov 14;12(11):e0188189. doi: 10.1371/journal.pone.0188189. eCollection 2017.
The prairie provinces of Canada.
To characterize tuberculosis (TB) transmission among the Indigenous and non-Indigenous Canadian-born peoples of the prairie provinces of Canada.
A prospective epidemiologic study of consecutively diagnosed adult (age ≥ 14 years) Canadian-born culture-positive pulmonary TB cases on the prairies, hereafter termed "potential transmitters," and the transmission events generated by them. "Transmission events" included new positive tuberculin skin tests (TSTs), TST conversions, and secondary cases among contacts.
In the years 2007 and 2008, 222 potential transmitters were diagnosed on the prairies. Of these, the vast majority (198; 89.2%) were Indigenous peoples who resided in either an Indigenous community (135; 68.2%) or a major metropolitan area (44; 22.2%). Over the 4.5-year period between July 1st, 2006 and December 31st 2010, 1085 transmission events occurred in connection with these potential transmitters. Most of these transmission events were attributable to potential transmitters who identified as Indigenous (94.5%). With a few notable exceptions most transmitters and their infected contacts resided in the same community type. In multivariate models positive smear status and a higher number of close contacts were associated with increased transmission; adjusted odds ratios (ORs) and 95% confidence intervals (CIs), 4.30 [1.88, 9.84] and 2.88 [1.31, 6.34], respectively. Among infected contacts, being Indigenous was associated with disease progression; OR and 95% CI, 3.59 [1.27, 10.14] and 6.89 [2.04, 23.25] depending upon Indigenous group, while being an infected casual contact was less likely than being a close contact to be associated with disease progression, 0.66 [0.44, 1.00].
In the prairie provinces of Canada and among Canadian-born persons, Indigenous peoples account for the vast majority of cases with the potential to transmit as well as the vast majority of infected contacts. Active case finding and preventative therapy measures need to focus on high-incidence Indigenous communities.
加拿大草原三省。
描述加拿大草原三省出生的原住民和非原住民人群中的结核病传播情况。
对草原地区连续诊断出的成年（年龄≥14岁）加拿大出生的痰培养阳性肺结核病例（以下称为“潜在传播者”）及其引发的传播事件进行前瞻性流行病学研究。“传播事件”包括新的结核菌素皮肤试验（TST）阳性、TST血清转换以及接触者中的二代病例。
2007年和2008年，草原地区诊断出222名潜在传播者。其中，绝大多数（198名；89.2%）是居住在原住民社区（135名；68.2%）或主要大都市地区（44名；22.2%）的原住民。在2006年7月1日至2010年12月31日的4.5年期间，与这些潜在传播者相关的传播事件有1085起。这些传播事件大多归因于自认为是原住民的潜在传播者（94.5%）。除了少数明显的例外情况，大多数传播者及其受感染的接触者居住在同一社区类型。在多变量模型中，涂片阳性状态和较多的密切接触者与传播增加相关；调整后的比值比（OR）和95%置信区间（CI）分别为4.30 [1.88, 9.84]和2.88 [1.31, 6.34]。在受感染的接触者中，原住民身份与疾病进展相关；根据原住民群体不同，OR和95%CI分别为3.59 [1.27, 10.14]和6.89 [2.04, 23.25]，而受感染的偶然接触者比密切接触者与疾病进展相关的可能性小，为0.66 [0.44, 1.00]。
在加拿大草原三省以及加拿大出生的人群中，原住民占绝大多数有传播可能的病例以及绝大多数受感染的接触者。主动病例发现和预防性治疗措施需要聚焦于高发病率的原住民社区。
