Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
BMC Med. 2021 Apr 20;19(1):95. doi: 10.1186/s12916-021-01968-9.
Large-scale rural-to-urban migration has changed the epidemiology of tuberculosis (TB) in large Chinese cities. We estimated the contribution of TB importation, reactivation of latent infection, and local transmission to new TB cases in Shanghai, and compared the potential impact of intervention options.
We developed a transmission dynamic model of TB for Songjiang District, Shanghai, which has experienced high migration over the past 25 years. We calibrated the model to local demographic data, TB notifications, and molecular epidemiologic studies. We estimated epidemiological drivers as well as future outcomes of current TB policies and compared this base-case scenario with scenarios describing additional targeted interventions focusing on migrants or vulnerable residents.
The model captured key demographic and epidemiological features of TB among migrant and resident populations in Songjiang District, Shanghai. Between 2020 and 2035, we estimate that over 60% of TB cases will occur among migrants and that approximately 43% of these cases will result from recent infection. While TB incidence will decline under current policies, we estimate that additional interventions-including active screening and preventive treatment for migrants-could reduce TB incidence by an additional 20% by 2035.
Migrant-focused TB interventions could produce meaningful health benefits for migrants, as well as for young residents who receive indirect protection as a result of reduced TB transmission in Shanghai. Further studies to measure cost-effectiveness are needed to evaluate the feasibility of these interventions in Shanghai and similar urban centers experiencing high migration volumes.
大规模的农村向城市移民改变了中国大城市的结核病（TB）流行病学。我们估计了结核病输入、潜伏感染再激活和本地传播对上海新发病例的贡献，并比较了干预措施的潜在影响。
我们为过去 25 年经历过大量移民的上海市松江区开发了结核病传播动力学模型。我们根据当地人口统计数据、结核病报告和分子流行病学研究对模型进行了校准。我们估计了流行病学驱动因素以及当前结核病政策的未来结果，并将这一基本情况与描述针对移民或弱势居民的额外针对性干预措施的情景进行了比较。
该模型捕捉到了上海松江区移民和本地居民中结核病的关键人口和流行病学特征。在 2020 年至 2035 年期间，我们估计超过 60%的结核病病例将发生在移民中，其中约 43%的病例将是由近期感染引起的。虽然现行政策将降低结核病的发病率，但我们估计，包括对移民进行主动筛查和预防性治疗在内的额外干预措施，到 2035 年可使结核病发病率再降低 20%。
针对移民的结核病干预措施可能会给移民带来显著的健康益处，也会给因上海结核病传播减少而间接受益的年轻居民带来益处。需要进一步研究来衡量成本效益，以评估这些干预措施在上海和类似经历大量移民的城市中心的可行性。
