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幼儿结核病接触者追踪:澳大利亚的一系列护理审查。

TB contact tracing for young children: an Australian cascade of care review.

作者信息

Moyo N, Tay E L, Nolan A, Graham H R, Graham S M, Denholm J T

机构信息

Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Australia.

School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia.

出版信息

Public Health Action. 2021 Jun 21;11(2):91-96. doi: 10.5588/pha.20.0086.

Abstract

OBJECTIVE

To evaluate care cascades for programmatic active case finding and latent TB infection (LTBI) management in young child TB contacts (aged <5 years) in Victoria, Australia.

DESIGN

This was a retrospective review of public health surveillance data to identify contacts of all pulmonary TB cases notified from 2016 to 2019.

RESULTS

Contact tracing identified 574 young child contacts of 251 pulmonary TB cases. Active TB was found in 28 (4.9%) contacts, none of whom had previously received bacille Calmette-Guérin vaccination, and 529 were tested for TB infection using the tuberculin skin test (TST). The overall TST positivity was 15.3% (95% CI 0.1-0.2). Among the 574 children, 150 (26.1%) were close contacts of sputum smear-positive cases and 25 (16.7%) of these were not referred to TB clinics. Of the 125 referred, 81 were considered to have LTBI, 79 agreed to commence TB preventive treatment (TPT) and 71 (89.9%) completed TPT. Following completion of TPT, no child was subsequently diagnosed with active TB.

CONCLUSION

There was a high yield from active case finding and uptake of TPT. Notable losses in the cascade of care occurred around referral to tertiary clinics, but high treatment completion rates and good outcomes were found in those prescribed treatment.

摘要

目的

评估澳大利亚维多利亚州针对5岁以下儿童结核病接触者开展的主动病例发现及潜伏性结核感染(LTBI)管理的照护流程。

设计

这是一项对公共卫生监测数据的回顾性研究,以确定2016年至2019年期间报告的所有肺结核病例的接触者。

结果

接触者追踪确定了251例肺结核病例的574名儿童接触者。在28名(4.9%)接触者中发现了活动性结核病,其中无一例之前接种过卡介苗,529名接触者接受了结核菌素皮肤试验(TST)以检测结核感染。总体TST阳性率为15.3%(95%CI 0.1 - 0.2)。在这574名儿童中,150名(26.1%)是痰涂片阳性病例的密切接触者,其中25名(16.7%)未被转诊至结核病诊所。在转诊的125名接触者中,81名被认为患有LTBI,79名同意开始结核病预防性治疗(TPT),71名(89.9%)完成了TPT。TPT完成后,没有儿童随后被诊断为活动性结核病。

结论

主动病例发现和TPT的接受率很高。在转诊至三级诊所前后的照护流程中出现了明显的流失,但接受规定治疗的患者治疗完成率高且预后良好。

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