Nelson M E, Fingar A R
Section of Preventive Medicine and Public Health, Ohio University College of Osteopathic Medicine, Athens 45701, USA.
Am J Prev Med. 1995 May-Jun;11(3 Suppl):48-54.
In the mid-1980s, international students enrolled at Ohio University were identified as a high-risk group for tuberculosis (TB), contributing an estimated 30%-50% of all active TB cases in the sparsely populated county where the university is located. While the student health center routinely screened all newly enrolled international students with PPD Mantoux tests, no provision for Isoniazid (INH) chemoprophylaxis was available until the Preventive Medicine/Public Health Section of Ohio University College of Osteopathic Medicine initiated a program in September 1985. In 1993, cases of active TB among international students had declined significantly from a pre-1986 rate of 97.5/100,000 student-years to 19.4/100,000 after 1986 (P < .01), while case rates among other groups in the county increased. Positive PPD reaction rates have remained high (53.6%), but less than 15% of international students who should have taken INH chemoprophylaxis by Centers for Disease Control (CDC) criteria did so. This finding suggests that other factors may have contributed to the observed decline in active cases. We examined the influence of five variables (age, gender, geographic origin, BCG vaccination status, and year of enrollment) on PPD status. In this international student population, geographic origin and BCG vaccination status were the most important contributors to positive PPD testing. We suggest that PPD status alone may no longer be sufficient to distinguish those at higher risk of developing active TB in similar populations. A changing mix in international students' geographic origin and BCG vaccination status may help explain the decrease in active case rates in the face of continued high positive PPD rates.
20世纪80年代中期，俄亥俄大学招收的国际学生被认定为结核病（TB）高危群体，在该大学所在的人口稀少的县，这些学生约占所有活动性结核病例的30%-50%。虽然学生健康中心会对所有新入学的国际学生定期进行结核菌素纯蛋白衍生物（PPD）曼托试验筛查，但直到1985年9月俄亥俄大学整骨医学院预防医学/公共卫生科启动一项计划之前，一直没有提供异烟肼（INH）化学预防措施。1993年，国际学生中的活动性结核病例从1986年前的每100000学生年97.5例显著下降至1986年后的每100000学生年19.4例（P<.01），而该县其他群体的病例率却有所上升。PPD阳性反应率一直居高不下（53.6%），但按照疾病控制中心（CDC）标准本应接受INH化学预防的国际学生中，只有不到15%的人这样做了。这一发现表明，可能还有其他因素导致了观察到的活动性病例下降。我们研究了五个变量（年龄、性别、地理来源、卡介苗接种状况和入学年份）对PPD状态的影响。在这个国际学生群体中，地理来源和卡介苗接种状况是PPD检测呈阳性的最重要因素。我们认为，仅靠PPD状态可能不足以区分相似人群中发生活动性结核风险较高的人群。国际学生地理来源和卡介苗接种状况的变化组合，可能有助于解释在PPD阳性率持续居高的情况下活动性病例率下降的原因。
