Victorian Tuberculosis Program, Melbourne Health, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
Clin Infect Dis. 2020 May 6;70(10):2111-2118. doi: 10.1093/cid/ciz569.
The risk of progression to tuberculosis (TB) disease is greatest soon after infection, yet disease may occur many years or decades later. However, rates of TB reactivation long after infection remain poorly quantified. Australia has a low incidence of TB and most cases occur among migrants. We explored how TB rates in Australian migrants varied with time from migration, age, and gender.
We combined TB notifications in census years 2006, 2011, and 2016 with time- and country-specific estimates of latent TB prevalences in migrant cohorts to quantify postmigration reactivation rates.
During the census years, 3246 TB cases occurred among an estimated 2 084 000 migrants with latent TB. There were consistent trends in postmigration reactivation rates, which appeared to be dependent on both time from migration and age. Rates were lower in cohorts with increasing time, until at least 20 years from migration, and on this background there also appeared to be increasing rates during youth (15-24 years of age) and in those aged 70 years and above. Within 5 years of migration, annual reactivation rates were approximately 400 per 100 000 (uncertainty interval [UI] 320-480), dropping to 170 (UI 130-220) from 5 to 10 years and 110 (UI 70-160) from 10 to 20 years, then sustaining at 60-70 per 100 000 up to 60 years from migration. Rates varied depending on age at migration.
Postmigration reactivation rates appeared to show dependency on both time from migration and age. This approach to quantifying reactivation risks will enable evaluations of the potential impacts of TB control and elimination strategies.
在感染后不久，进展为结核病（TB）的风险最大，但疾病可能在数年后或数十年后才发生。然而，感染后很久再次发生 TB 的确切比率仍未得到充分量化。澳大利亚的结核病发病率较低，大多数病例发生在移民中。我们探讨了澳大利亚移民的 TB 发病率如何随移民时间、年龄和性别而变化。
我们将 2006 年、2011 年和 2016 年的人口普查年份中的结核病报告病例与移民队列中潜伏性结核病的时间和国家特定流行率估计值相结合，以量化移民后的再激活率。
在人口普查年份，3246 例结核病病例发生在估计有 2084000 例潜伏性结核病的移民中。移民后的再激活率存在一致的趋势，这些趋势似乎取决于移民时间和年龄。在移民时间较长的队列中，比率较低，直到至少 20 年之后，在此背景下，青年（15-24 岁）和 70 岁及以上人群的比率似乎也在增加。在移民后的 5 年内，每年的再激活率约为 400/100000（不确定区间[UI]320-480），从第 5 年到第 10 年降至 170/100000（UI 130-220），从第 10 年到第 20 年降至 110/100000（UI 70-160），然后在移民后 60 年内维持在 60-70/100000。比率因移民时的年龄而异。
移民后的再激活率似乎取决于移民时间和年龄。这种量化再激活风险的方法将能够评估 TB 控制和消除策略的潜在影响。
