Department of Clinical Infection, Microbiology, and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
Department of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
Thorax. 2018 Aug;73(8):785-787. doi: 10.1136/thoraxjnl-2017-210202. Epub 2017 Nov 16.
UK guidelines no longer recommend routine screening of household contacts of adult patients with extrapulmonary TB (EPTB). From 27 March 2012 to 28 June 2016, we investigated the prevalence of active TB disease in household contacts of 1023 EPTB index cases in North West England, and compared estimates with: published new entrant migrant screening programme prevalence (~147/100 000 person-years); London-based contact screening data (700/100 000 contacts screened); and National Institute for Health and Care Excellence (NICE) new entrant TB screening thresholds (TB prevalence >40/100 000 people). Active TB disease prevalence in EPTB contacts was 440/100 000 contacts screened, similar to UK new entrant screening programmes, London EPTB contact prevalence and >10 times NICE's threshold for new entrant screening. The decision to no longer recommend routine screening of EPTB contacts should be re-evaluated and cost-effectiveness analyses of screening strategies for EPTB contacts should be performed.
英国指南不再建议对成人肺外结核（EPTB）患者的家庭接触者进行常规筛查。从 2012 年 3 月 27 日至 2016 年 6 月 28 日，我们调查了英格兰西北部 1023 例 EPTB 指数病例的家庭接触者中活动性结核病的患病率，并将估计值与以下情况进行了比较：已公布的新移民筛查计划的患病率（约 147/100000 人年）；基于伦敦的接触者筛查数据（700/100000 名接触者筛查）；以及国家卫生与保健卓越研究所（NICE）的新移民结核病筛查阈值（TB 患病率>40/100000 人）。EPTB 接触者中活动性结核病的患病率为 440/100000 名接触者筛查，与英国新移民筛查计划、伦敦 EPTB 接触者患病率相似，且是 NICE 新移民筛查阈值的 10 多倍。不再建议对 EPTB 接触者进行常规筛查的决定应重新评估，并应进行 EPTB 接触者筛查策略的成本效益分析。
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