From the Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston MA.
Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention, Atlanta GA.
Epidemiology. 2024 Mar 1;35(2):164-173. doi: 10.1097/EDE.0000000000001707. Epub 2023 Jan 30.
In the United States, over 80% of tuberculosis (TB) disease cases are estimated to result from reactivation of latent TB infection (LTBI) acquired more than 2 years previously ("reactivation TB"). We estimated reactivation TB rates for the US population with LTBI, overall, by age, sex, race-ethnicity, and US-born status, and for selected comorbidities (diabetes, end-stage renal disease, and HIV).
We collated nationally representative data for 2011-2012. Reactivation TB incidence was based on TB cases reported to the National TB Surveillance System that were attributed to LTBI reactivation. Person-years at risk of reactivation TB were calculated using interferon-gamma release assay (IGRA) positivity from the National Health and Nutrition Examination Survey, published values for interferon-gamma release assay sensitivity and specificity, and population estimates from the American Community Survey.
For persons aged ≥6 years with LTBI, the overall reactivation rate was estimated as 0.072 (95% uncertainty interval: 0.047, 0.12) per 100 person-years. Estimated reactivation rates declined with age. Compared to the overall population, estimated reactivation rates were higher for persons with diabetes (adjusted rate ratio [aRR] = 1.6 [1.5, 1.7]), end-stage renal disease (aRR = 9.8 [5.4, 19]), and HIV (aRR = 12 [10, 13]).
In our study, individuals with LTBI faced small, non-negligible risks of reactivation TB. Risks were elevated for individuals with medical comorbidities that weaken immune function.
在美国，超过 80%的结核病 (TB) 病例估计是由 2 年多前获得的潜伏性 TB 感染 (LTBI) 再激活引起的(“再激活 TB”)。我们估计了 LTBI 美国人群的再激活 TB 发生率，包括总体情况、年龄、性别、种族和美国出生情况，以及一些合并症(糖尿病、终末期肾病和 HIV)。
我们整理了 2011-2012 年具有全国代表性的数据。再激活 TB 的发病率是基于向国家 TB 监测系统报告的归因于 LTBI 再激活的 TB 病例。再激活 TB 的发病风险人年数是根据全国健康和营养检查调查中的干扰素-γ释放试验 (IGRA) 阳性、干扰素-γ释放试验的灵敏度和特异性的公布值以及美国社区调查的人口估计数计算得出的。
对于年龄≥6 岁且 LTBI 的人，总体再激活率估计为每 100 人年 0.072(95%不确定区间：0.047，0.12)。估计的再激活率随年龄下降。与总人口相比，糖尿病(调整后的发病率比[aRR] = 1.6 [1.5，1.7])、终末期肾病(aRR = 9.8 [5.4，19])和 HIV(aRR = 12 [10，13])患者的再激活率更高。
在我们的研究中，LTBI 个体面临着再激活 TB 的小而不可忽视的风险。患有削弱免疫功能的合并症的个体风险更高。
