Nathavitharana Ruvandhi R, Pearl Abarna, Biewer Amanda, Young Laura, Mukasa Leonard, Delrooz Naveed, Subramanian Advaith, Miller Sarah, Mase Sundari, Munsiff Sonal S, Nardell Edward
Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Virginia Department of Health, Virginia, USA.
Clin Infect Dis. 2025 Feb 5;80(1):189-198. doi: 10.1093/cid/ciae496.
Respiratory isolation of people with pulmonary tuberculosis (TB), including after treatment initiation, is used to prevent community-based transmission; yet guidelines on duration are limited and implementation is heterogeneous. This systematic review synthesized evidence on respiratory isolation for TB to inform National TB Coalition of America guidelines.
After searching 6 databases, 8 reviewers screened and extracted data in duplicate on effects of respiratory isolation compared to no isolation or masking. Studies were stratified by outcomes: TB infection or disease in contacts, mortality, hospitalization duration, patient and health system costs, and impact on mental health or stigma. We used a convergent integrated approach to synthesize quantitative and qualitative findings and assess limitations.
Seventeen studies were included. There were limited data directly comparing isolation to non-isolation interventions, including effects after treatment initiation. One randomized controlled trial suggested treatment in a sanatorium versus at home did not affect TB incidence in contacts. Modeling studies suggest isolation may reduce transmission but relied on various assumptions, and isolation was implemented alongside other interventions. Descriptive, mixed-methods, and qualitative studies described adverse impacts of isolation on employment, education, food/housing security, and mental health due to transmission fears, stigma, and social isolation. Impacts were compounded in marginalized groups including Indigenous and incarcerated persons.
Data to support current isolation practices, particularly after effective treatment initiation, to reduce TB transmission in communities are limited. Public health guidance should weigh the negative impacts on people with TB against decreased community transmission to make evidence-based decisions about respiratory isolation.
对肺结核患者进行呼吸道隔离，包括在开始治疗后，用于预防社区传播；然而，关于隔离持续时间的指南有限，且实施情况参差不齐。本系统评价综合了关于肺结核呼吸道隔离的证据，以为美国国家结核病联盟的指南提供参考。
在检索6个数据库后，8名评审员对呼吸道隔离与不隔离或戴口罩相比的效果进行了重复筛选和数据提取。研究按结果分层：接触者中的结核感染或疾病、死亡率、住院时间、患者和卫生系统成本，以及对心理健康或耻辱感的影响。我们采用了一种收敛性综合方法来综合定量和定性研究结果，并评估局限性。
纳入了17项研究。直接比较隔离与非隔离干预措施的数据有限，包括开始治疗后的效果。一项随机对照试验表明，在疗养院与在家治疗对接触者中的结核病发病率没有影响。模型研究表明隔离可能会减少传播，但依赖于各种假设，并且隔离是与其他干预措施一起实施的。描述性、混合方法和定性研究描述了由于传播恐惧、耻辱感和社会隔离，隔离对就业、教育、粮食/住房安全和心理健康产生的不利影响。在包括原住民和被监禁者在内的边缘化群体中，这些影响更为严重。
支持当前隔离措施（尤其是在有效治疗开始后）以减少社区中结核传播的数据有限。公共卫生指南应权衡对肺结核患者的负面影响与社区传播减少之间的关系，以便就呼吸道隔离做出基于证据的决策。
