2014-2018 年美国大规模结核病爆发的分子监测。
Molecular surveillance for large outbreaks of tuberculosis in the United States, 2014-2018.
机构信息
Centers for Disease Control and Prevention, Atlanta, GA, USA.
Centers for Disease Control and Prevention, Atlanta, GA, USA.
出版信息
Tuberculosis (Edinb). 2022 Sep;136:102232. doi: 10.1016/j.tube.2022.102232. Epub 2022 Aug 9.
OBJECTIVE
This study describes characteristics of large tuberculosis (TB) outbreaks in the United States detected using novel molecular surveillance methods during 2014-2016 and followed for 2 years through 2018.
METHODS
We developed 4 genotype-based detection algorithms to identify large TB outbreaks of ≥10 cases related by recent transmission during a 3-year period. We used whole-genome sequencing and epidemiologic data to assess evidence of recent transmission among cases.
RESULTS
There were 24 large outbreaks involving 518 cases; patients were primarily U.S.-born (85.1%) racial/ethnic minorities (84.1%). Compared with all other TB patients, patients associated with large outbreaks were more likely to report substance use, homelessness, and having been diagnosed while incarcerated. Most large outbreaks primarily occurred within residences among families and nonfamilial social contacts. A source case with a prolonged infectious period and difficulties in eliciting contacts were commonly reported contributors to transmission.
CONCLUSION
Large outbreak surveillance can inform targeted interventions to decrease outbreak-associated TB morbidity.
目的
本研究描述了 2014 年至 2016 年期间，使用新型分子监测方法在美国发现的大型结核病（TB）暴发的特征，并在 2018 年通过 2 年的随访进行了跟踪。
方法
我们开发了 4 种基于基因型的检测算法，以确定在 3 年内与近期传播有关的≥10 例相关的大型 TB 暴发。我们使用全基因组测序和流行病学数据评估病例之间近期传播的证据。
结果
有 24 起涉及 518 例的大型暴发；患者主要为美国出生（85.1%）的少数族裔（84.1%）。与所有其他结核病患者相比，与大型暴发相关的患者更有可能报告药物滥用、无家可归以及在被监禁期间被诊断患有结核病。大多数大型暴发主要发生在家庭和非家庭社会接触者的住所内。传播的常见原因是源病例具有较长的传染性潜伏期和难以接触到接触者。
结论
大型暴发监测可以为减少暴发相关结核病发病率提供有针对性的干预措施。
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