Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil.
Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil.
Lancet Infect Dis. 2024 Jan;24(1):46-56. doi: 10.1016/S1473-3099(23)00371-7. Epub 2023 Aug 14.
Although household contacts of patients with tuberculosis are known to be particularly vulnerable to tuberculosis, the published evidence focused on this group at high risk within the low-income and middle-income country context remains sparse. Using nationwide data from Brazil, we aimed to estimate the incidence and investigate the socioeconomic and clinical determinants of tuberculosis in a cohort of contacts of tuberculosis patients.
In this cohort study, we linked individual socioeconomic and demographic data from the 100 Million Brazilian Cohort to mortality data and tuberculosis registries, identified contacts of tuberculosis index patients diagnosed from Jan 1, 2004 to Dec 31, 2018, and followed up the contacts until the contact's subsequent tuberculosis diagnosis, the contact's death, or Dec 31, 2018. We investigated factors associated with active tuberculosis using multilevel Poisson regressions, allowing for municipality-level and household-level random effects.
We studied 420 854 household contacts of 137 131 tuberculosis index patients. During the 15 years of follow-up (median 4·4 years [IQR 1·9-7·6]), we detected 8953 contacts with tuberculosis. The tuberculosis incidence among contacts was 427·8 per 100 000 person-years at risk (95% CI 419·1-436·8), 16-times higher than the incidence in the general population (26·2 [26·1-26·3]) and the risk was prolonged. Tuberculosis incidence was associated with the index patient being preschool aged (<5 years; adjusted risk ratio 4·15 [95% CI 3·26-5·28]) or having pulmonary tuberculosis (2·84 [2·55-3·17]).
The high and sustained risk of tuberculosis among contacts reinforces the need to systematically expand and strengthen contact tracing and preventive treatment policies in Brazil in order to achieve national and international targets for tuberculosis elimination.
Wellcome Trust and Brazilian Ministry of Health.
已知结核病患者的家庭接触者特别容易感染结核病，但在低收入和中等收入国家背景下，针对这一高危人群的相关研究仍然很少。本研究利用巴西全国范围内的数据，旨在估计接触者的结核病发病率，并调查接触者队列中结核病的社会经济和临床决定因素。
在这项队列研究中，我们将来自 1 亿巴西人队列的个人社会经济和人口统计学数据与死亡率数据和结核病登记处进行了关联，确定了 2004 年 1 月 1 日至 2018 年 12 月 31 日期间诊断出的结核病指数患者的接触者，并对接触者进行了随访，直至接触者随后被诊断出结核病、接触者死亡或 2018 年 12 月 31 日。我们使用多水平泊松回归调查了与活动性结核病相关的因素，允许在市和家庭层面上存在随机效应。
我们研究了 137131 例结核病指数患者的 420854 名家庭接触者。在 15 年的随访期间（中位数 4.4 年[IQR 1.9-7.6]），我们共发现了 8953 例结核病接触者。接触者的结核病发病率为每 100000 人年 427.8 例（95%CI 419.1-436.8），是普通人群（26.2[26.1-26.3]）发病率的 16 倍，且风险持续存在。结核病发病率与指数患者为学龄前儿童（<5 岁；调整后的风险比 4.15[95%CI 3.26-5.28]）或患有肺结核（2.84[2.55-3.17]）有关。
接触者结核病的高发病率和持续存在，这突显了巴西需要有系统地扩大和加强接触者追踪和预防治疗政策，以实现国家和国际消除结核病的目标。
惠康信托基金会和巴西卫生部。
