Dr. P.H. Candidate, Major in Epidemiology, Faculty of Public Health, Mahidol University, Thailand.
Department of Epidemiology, Faculty of Public Health, Mahidol University, Thailand.
J Formos Med Assoc. 2019 Aug;118(8):1255-1265. doi: 10.1016/j.jfma.2018.11.016. Epub 2019 Jan 10.
We aimed to estimate TB prevalence among in-patients hospitalized with acute lower respiratory infection (ALRI) through a routine TB case finding approach (Patient-Initiated-Pathway, PIP) and among those without initial TB detection by PIP using a supplementary-Intensified-Case-Finding (supplementary-ICF) approach to determine the extent of active TB infection in patients enrolled in population-based surveillance in Sa Keao, Thailand. We also investigated secondary TB transmission through household contacts (HHCs).
This was a prospective cross-sectional study. Data for hospitalized patients with ALRI were obtained from population-based pneumonia surveillance. PIP was provided in ALRI patients with suspected TB infection; those without initial suspicion of TB infection were evaluated for TB by the supplementary-ICF approach. For each active TB case finding approach, index cases were identified by acid-fast-bacillus testing and the TB prevalence was estimated. HHCs of each TB index case were followed to identify the extent of secondary TB infection.
TB prevalence among ALRI hospitalized patients was 12.2% among those undergoing PIP and 6.8% among those undergoing supplementary-ICF. The total number of active TB cases was doubled after implementing the supplementary-ICF method. Secondary TB infection among HHCs was 3.5 times more common for contacts of index cases identified by routine active TB case finding compared to supplementary-ICF TB.
Supplementary-ICF among ALRI hospitalizations would be expected to result in improved active TB case detection compared to the current policy of PIP. The supplementary-ICF also enhanced early case detection and showed lower prevalence of secondary infection.
本研究旨在通过常规结核病例发现途径（患者主动上报途径，PIP）估算因急性下呼吸道感染（ALRI）住院患者中的结核患病率，并通过补充强化病例发现途径（supplementary-ICF）估算 PIP 未发现初始结核的患者中的结核患病率，以明确泰国沙缴府基于人群的监测中入组患者的活动性结核感染程度。我们还调查了家庭接触者（HHCs）中的继发性结核传播。
这是一项前瞻性的横断面研究。从基于人群的肺炎监测中获取 ALRI 住院患者的数据。对疑似结核感染的 ALRI 患者提供 PIP；对未初始怀疑结核感染的患者，采用 supplementary-ICF 方法评估 TB。对于每种活动性结核病例发现方法，通过抗酸杆菌检测确定指标病例，并估算结核患病率。对每个结核指标病例的 HHCs 进行随访，以确定继发性结核感染的程度。
接受 PIP 的 ALRI 住院患者中的结核患病率为 12.2%，接受 supplementary-ICF 的患者中的结核患病率为 6.8%。实施 supplementary-ICF 方法后，活动性结核病例的总数增加了一倍。与 supplementary-ICF 相比，常规活动性结核病例发现方法确定的指标病例的 HHCs 继发性结核感染的发生率增加了 3.5 倍。
与目前的 PIP 政策相比，对 ALRI 住院患者实施 supplementary-ICF 预计会提高活动性结核病例的检出率。supplementary-ICF 还能更早地发现病例，并显示出较低的继发感染率。
