Field Service, National Infection Service, Public Health England, London, United Kingdom.
European Public Health Microbiology Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
PLoS One. 2019 Feb 15;14(2):e0211972. doi: 10.1371/journal.pone.0211972. eCollection 2019.
Recurrence of TB in an individual can occur due to relapse of the same strain or reinfection by a different strain. The contribution of reinfection and relapse to TB incidence, and the factors associated with each are unknown. We aimed to quantify and describe cases attributable to relapse or reinfection, and identify associated risk factors in order to reduce recurrence. We categorised recurrent TB cases from notifications in London (2002-2015) as relapse or reinfection using molecular (MIRU VNTR strain type) and epidemiological information (hierarchical approach using time since notification, site of disease and method of case finding). Factors associated with each outcome were determined using logistic regression in Stata Version 13.1 (2009-2015 only). Of 43,465 TB cases, 1.4% (618) were classified as relapse and 3.8% (1,637) as reinfection. The proportion with relapse decreased from 2002 (2.3%) to 2015 (1.3%), while the proportion of reinfection remained around 4%. Relapse was more common among recent migrants (<1 year, odds ratio (OR) = 1.99, p = 0.005), those with a social risk factor (OR = 1.51, p = 0.033) and those with central nervous system, spinal, miliary or disseminated TB (OR = 1.75, p = 0.001). Reinfection was more common among long term migrants (>11 years, OR = 1.67, p = <0.001), those with a social risk factor (OR = 1.96, p = <0.001) and within specific areas in London. Patients with social risk factors were at increased risk of both relapse and reinfection. Characterising those with relapsed disease highlights patients at risk and factors associated with reinfection suggest groups where transmission is occurring. This will inform TB control programs to target appropriate treatment and interventions in order to reduce the risk of recurrence.
个体中 TB 的复发可能是由于同一菌株的复发或不同菌株的再感染引起的。再感染和复发对 TB 发病率的贡献以及与每种情况相关的因素尚不清楚。我们的目的是量化和描述归因于复发或再感染的病例，并确定相关的危险因素，以减少复发。我们使用分子（MIRU VNTR 菌株类型）和流行病学信息（使用通知后时间、疾病部位和病例发现方法的分层方法）将伦敦（2002-2015 年）的通知中复发的 TB 病例归类为复发或再感染。使用 Stata 版本 13.1（仅 2009-2015 年）中的逻辑回归确定每种结果的相关因素。在 43465 例 TB 病例中，有 1.4%（618 例）被归类为复发，3.8%（1637 例）为再感染。从 2002 年（2.3%）到 2015 年（1.3%），复发的比例下降，而再感染的比例保持在 4%左右。最近移民（<1 年，比值比（OR）=1.99，p=0.005）、有社会危险因素（OR=1.51，p=0.033）和有中枢神经系统、脊柱、粟粒性或播散性 TB 的患者（OR=1.75，p=0.001）中更常见。长期移民（>11 年，OR=1.67，p<0.001）、有社会危险因素（OR=1.96，p<0.001）和伦敦特定地区的患者中更常见再感染。有社会危险因素的患者复发和再感染的风险增加。描述复发疾病的患者突出了处于危险中的患者，以及与再感染相关的因素表明正在发生传播的群体。这将为结核病控制计划提供信息，以针对适当的治疗和干预措施，以降低复发的风险。
