Khan Palwasha Y, Paracha Mohammed Shariq, Grundy Chris, Madhani Falak, Saeed Saadia, Maniar Lamis, Dojki Maqboola, Page-Shipp Liesl, Khursheed Nazia, Rabbani Waleed, Riaz Najam, Khowaja Saira, Hussain Owais, Maniar Rabia, Khan Uzma, Khan Salman, Kazmi Syed S H, Dahri Ali A, Ghafoor Abdul, Tahseen Sabira, Habib Ali, Lewis James J, Kranzer Katharina, Ferrand Rashida A, Fielding Katherine L, Khan Aamir J
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Africa Health Research Institute, Durban, South Africa.
PLOS Glob Public Health. 2024 Aug 28;4(8):e0002155. doi: 10.1371/journal.pgph.0002155. eCollection 2024.
Pakistan is one of the five highest tuberculosis burden countries globally. We estimated prevalence of adult bacteriologically confirmed pulmonary tuberculosis and annual risk of Mycobacterium tuberculosis (M. tuberculosis) infection in children aged 2-4 years in Karachi, Pakistan. The survey design enabled exploration of tuberculosis burden by whether the population had previously been exposed to widespread tuberculosis active case-finding (ACF) activities or not. We conducted a concurrent adult pulmonary tuberculosis prevalence survey and a child M. tuberculosis infection survey using interferon gamma release assays in four districts (Korangi, South, West and Central). A cluster-based unequal probability random sampling method was employed with the a priori plan to oversample Korangi district which had been the focus of tuberculosis ACF activities since 2011. We defined Korangi district as the 'prior ACF' zone and remaining districts as the 'no prior ACF' zone. Between March 2018 and May 2019, 34,962 adults (78·5% of those eligible) and 1,505 children (59·9%) participated. Overall estimated prevalence of bacteriologically confirmed pulmonary tuberculosis was 387 cases per 100,000 population (95% CI 276-498) with a prevalence of 421 cases [95% CI 276-567] per 100,000 in the 'no prior ACF' and 279 cases [95% CI 155-403] per 100,000 in the 'prior ACF' zone. We estimated the annual risk of M. tuberculosis infection in children to be 1·1% (95% CI 0·7-1·5) in the 'no prior ACF' zone and 0·6% (95% CI 0·3-1·1) in the 'prior ACF' zone. We observed consistent differences in the population distribution of tuberculosis between the 'prior ACF' and 'no prior' ACF zones with a trend towards lower estimates of burden and M. tuberculosis transmission in the 'prior ACF' zone. A plausible explanation is that intensive ACF activities that have been ongoing in Korangi district for the preceding years have noticeably reduced the burden of tuberculosis and transmission.
巴基斯坦是全球结核病负担最高的五个国家之一。我们估算了巴基斯坦卡拉奇2至4岁儿童结核分枝杆菌（M. tuberculosis）感染的年度风险以及成人菌阳确诊肺结核的患病率。该调查设计能够依据人群此前是否接触过广泛开展的结核病主动病例发现（ACF）活动来探究结核病负担情况。我们在四个区（科兰吉、南区、西区和中区）同时开展了成人肺结核患病率调查以及采用干扰素γ释放试验的儿童结核分枝杆菌感染调查。采用基于整群的不等概率随机抽样方法，并预先计划对自2011年以来一直是结核病ACF活动重点的科兰吉区进行过抽样。我们将科兰吉区定义为“先前开展过ACF活动”区域，其余区域定义为“未开展过ACF活动”区域。在2018年3月至2019年5月期间，34962名成人（占 eligible的78.5%）和1505名儿童（占59.9%）参与了调查。总体菌阳确诊肺结核的估计患病率为每10万人387例（95%CI 276 - 498），其中“未开展过ACF活动”区域每10万人患病率为421例[95%CI 276 - 567]，“先前开展过ACF活动”区域每10万人患病率为279例[95%CI 155 - 403]。我们估计“未开展过ACF活动”区域儿童结核分枝杆菌感染的年度风险为1.1%（95%CI 0.7 - 1.5），“先前开展过ACF活动”区域为0.6%（95%CI 0.3 - 1.1）。我们观察到“先前开展过ACF活动”区域和“未开展过ACF活动”区域之间结核病的人群分布存在持续差异，“先前开展过ACF活动”区域的负担和结核分枝杆菌传播估计值有降低趋势。一个合理的解释是，科兰吉区前几年持续开展的密集ACF活动显著降低了结核病负担和传播。
