世界卫生组织潜伏性结核病筛查指南在低结核病发病率地区的影响估计：回顾性队列研究。
Estimated Impact of World Health Organization Latent Tuberculosis Screening Guidelines in a Region With a Low Tuberculosis Incidence: Retrospective Cohort Study.
机构信息
British Columbia Centre for Disease Control, Vancouver.
McGill International Tuberculosis Centre, Montreal.
出版信息
Clin Infect Dis. 2019 Nov 27;69(12):2101-2108. doi: 10.1093/cid/ciz188.
BACKGROUND
Latent tuberculosis infection (LTBI) screening and treatment is a key component of the World Health Organization (WHO) EndTB Strategy, but the impact of LTBI screening and treatment at a population level is unclear. We aimed to estimate the impact of LTBI screening and treatment in a population of migrants to British Columbia (BC), Canada.
METHODS
This retrospective cohort included all individuals (N = 1 080 908) who immigrated to Canada as permanent residents between 1985 and 2012 and were residents in BC at any time up to 2013. Multiple administrative databases were linked to identify people with risk factors who met the WHO strong recommendations for screening: people with tuberculosis (TB) contact, with human immunodeficiency virus, on dialysis, with tumor necrosis factor-alpha inhibitors, who had an organ/haematological transplant, or with silicosis. Additional TB risk factors included immunosuppressive medications, cancer, diabetes, and migration from a country with a high TB burden. We defined active TB as preventable if diagnosed ≥6 months after a risk factor diagnosis. We estimated the number of preventable TB cases, given optimal LTBI screening and treatment, based on these risk factors.
RESULTS
There were 16 085 people (1.5%) identified with WHO strong risk factors. Of the 2814 people with active TB, 118 (4.2%) were considered preventable through screening with WHO risk factors. Less than half (49.4%) were considered preventable with expanded screening to include people migrating from countries with high TB burdens, people who had been prescribed immunosuppressive medications, or people with diabetes or cancer.
CONCLUSIONS
The application of WHO LTBI strong recommendations for screening would have minimally impacted the TB incidence in this population. Further high-risk groups must be identified to develop an effective LTBI screening and treatment strategy for low-incidence regions.
背景
潜伏性结核感染（LTBI）筛查和治疗是世界卫生组织（WHO）终止结核病战略的一个关键组成部分，但在人群层面上 LTBI 筛查和治疗的影响尚不清楚。我们旨在评估 LTBI 筛查和治疗对加拿大不列颠哥伦比亚省（BC）移民人群的影响。
方法
本回顾性队列纳入了所有（N=1 080 908）在 1985 年至 2012 年期间作为永久居民移民到加拿大且在 2013 年之前任何时候都居住在 BC 的个体。多个行政数据库被链接起来，以确定符合 WHO 强烈推荐筛查标准的具有风险因素的人群：与结核病（TB）接触者、人类免疫缺陷病毒感染者、透析患者、使用肿瘤坏死因子-α抑制剂者、接受过器官/血液系统移植者或患有矽肺者。其他 TB 风险因素包括免疫抑制药物、癌症、糖尿病和来自结核病负担高的国家的移民。如果在风险因素诊断后≥6 个月诊断出活动性 TB，则将其定义为可预防。我们根据这些风险因素，估计在最优 LTBI 筛查和治疗的情况下，可预防的可预防性 TB 病例数。
结果
确定了 16085 人（1.5%）具有 WHO 强烈风险因素。在 2814 例活动性 TB 患者中，有 118 例（4.2%）可通过 WHO 风险因素筛查进行预防。不到一半（49.4%）可通过扩大筛查范围来预防，包括来自结核病负担高的国家的移民、使用免疫抑制药物的患者、患有糖尿病或癌症的患者。
结论
在该人群中，应用 WHO LTBI 强烈筛查建议对 TB 发病率的影响极小。必须进一步确定高风险群体，以制定低发病率地区有效的 LTBI 筛查和治疗策略。
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