2008 年至 2020 年，低发病国家输入性耐多药结核病：一项 GeoSentinel 分析。

Multidrug-resistant tuberculosis imported into low-incidence countries-a GeoSentinel analysis, 2008-2020.

机构信息

Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.

Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

出版信息

J Travel Med. 2021 Aug 27;28(6). doi: 10.1093/jtm/taab069.

DOI:10.1093/jtm/taab069

PMID:33987682

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9638878/

Abstract

BACKGROUND

Early detection of imported multidrug-resistant tuberculosis (MDR-TB) is crucial, but knowledge gaps remain about migration- and travel-associated MDR-TB epidemiology. The aim was to describe epidemiologic characteristics among international travellers and migrants with MDR-TB.

METHODS

Clinician-determined and microbiologically confirmed MDR-TB diagnoses deemed to be related to travel or migration were extracted from GeoSentinel, a global surveillance network of travel and tropical medicine clinics, from January 2008 through December 2020. MDR-TB was defined as resistance to both isoniazid and rifampicin. Additional resistance to either a fluoroquinolone or a second-line injectable drug was categorized as pre-extensively drug-resistant (pre-XDR) TB, and as extensively drug-resistant (XDR) TB when resistance was detected for both. Sub-analyses were performed based on degree of resistance and country of origin.

RESULTS

Of 201 patients, 136 had MDR-TB (67.7%), 25 had XDR-TB (12.4%), 23 had pre-XDR TB (11.4%) and 17 had unspecified MDR- or XDR-TB (8.5%); 196 (97.5%) were immigrants, of which 92 (45.8%) originated from the former Soviet Union. The median interval from arrival to presentation was 154 days (interquartile range [IQR]: 10-751 days); 34.3% of patients presented within 1 month after immigration, 30.9% between 1 and 12 months and 34.9% after ≥1 year. Pre-XDR- and XDR-TB patients from the former Soviet Union other than Georgia presented earlier than those with MDR-TB (26 days [IQR: 8-522] vs. 369 days [IQR: 84-827]), while patients from Georgia presented very early, irrespective of the level of resistance (8 days [IQR: 2-18] vs. 2 days [IQR: 1-17]).

CONCLUSIONS

MDR-TB is uncommon in traditional travellers. Purposeful medical migration may partly explain differences in time to presentation among different groups. Public health resources are needed to better understand factors contributing to cross-border MDR-TB spread and to develop strategies to optimize care of TB-infected patients in their home countries before migration.

摘要

背景

早期发现输入性耐多药结核病（MDR-TB）至关重要，但对与移民和旅行相关的 MDR-TB 流行病学仍存在知识空白。本研究旨在描述国际旅行者和移民中 MDR-TB 的流行病学特征。

方法

从 2008 年 1 月至 2020 年 12 月，从全球旅行和热带医学诊所监测网络 GeoSentinel 中提取临床医生诊断并经微生物学证实与旅行或移民有关的 MDR-TB 病例。MDR-TB 定义为对异烟肼和利福平均耐药。如果对氟喹诺酮类药物或二线注射类药物中的任何一种药物耐药，则归类为耐多药-利福平初步广泛耐药（pre-XDR）结核病，如果对两种药物均耐药，则归类为广泛耐药（XDR）结核病。基于耐药程度和原籍国进行了亚组分析。

结果

在 201 例患者中，136 例（67.7%）患有 MDR-TB，25 例（12.4%）患有 XDR-TB，23 例（11.4%）患有 pre-XDR-TB，17 例（8.5%）患有未明确的 MDR 或 XDR-TB；196 例（97.5%）为移民，其中 92 例（45.8%）来自前苏联。从到达到就诊的中位时间间隔为 154 天（四分位距[IQR]：10-751 天）；34.3%的患者在移民后 1 个月内就诊，30.9%在 1 至 12 个月内就诊，34.9%在≥1 年后就诊。来自前苏联非格鲁吉亚地区的 pre-XDR 和 XDR-TB 患者比 MDR-TB 患者更早就诊（26 天[IQR：8-522]比 369 天[IQR：84-827]），而格鲁吉亚患者无论耐药程度如何均就诊较早（8 天[IQR：2-18]比 2 天[IQR：1-17]）。