Favez G, Leuenberger P
Schweiz Med Wochenschr. 1983 Jan 22;113(3):96-9.
A patient with positive smear tuberculosis infects approximately 50% of his domestic contacts; post-primary morbidity may reach 10% of the cases infected under the age of 24 years. Infection rate among professional and social contacts is low and the morbidity much lower. Smear-positive tuberculous patients develop the disease in a few months, therefore indiscriminate case finding is not effective in disclosing patients before they are infectious. Smear-negative, culture-positive patients do not play a role as far as epidemiology is concerned. Prognostic significance of tuberculin conversion depends upon the duration and closeness of the contact with the infectious patient, and chemoprophylaxis of infected contacts reduces post-primary morbidity. Chemotherapy of smear-positive patients suppresses infectiousness in a few weeks, where it lasted for several months previously. Therefore hospitalization of treated patients does not afford additional protection to contacts, and disinfection is superfluous. In a country where tuberculosis prevalence is low, the influence of BCG vaccination in decreasing morbidity can hardly be demonstrated. The three main antituberculous measures remain case-finding of smear-positive patients, identification of infected domestic contacts, and their treatment.
涂片阳性肺结核患者会感染约50%的家庭接触者；初发后发病率在24岁以下受感染病例中可能达到10%。职业和社会接触者中的感染率较低，发病率更低。涂片阳性结核患者在几个月内就会发病，因此不加选择地查找病例在患者具有传染性之前发现患者方面效果不佳。就流行病学而言，涂片阴性、培养阳性患者不起作用。结核菌素阳转的预后意义取决于与感染患者接触的持续时间和密切程度，对受感染接触者进行化学预防可降低初发后发病率。涂片阳性患者的化疗在几周内就能抑制传染性，而此前传染性可持续数月。因此，对接受治疗的患者进行住院治疗并不能为接触者提供额外保护，消毒也没有必要。在结核病患病率较低的国家，几乎无法证明卡介苗接种在降低发病率方面的影响。三项主要的抗结核措施仍然是查找涂片阳性患者、识别受感染的家庭接触者并对其进行治疗。
