Borgdorff M W, Nagelkerke N, van Soolingen D, de Haas P E, Veen J, van Embden J D
Department of Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
Am J Epidemiol. 1998 Jan 15;147(2):187-95. doi: 10.1093/oxfordjournals.aje.a009433.
Immigration from high prevalence areas may contribute to an increased risk of tuberculosis in Europe. This study aimed at quantifying transmission of tuberculosis between and within nationalities among residents of the Netherlands. DNA "fingerprints," on the basis of restriction fragment length polymorphism using marker IS6110, were made of all Mycobacterium tuberculosis isolates in the Netherlands from January 1993 through June 1995. Clusters were defined as groups of patients that had isolates with identical fingerprints. It was assumed that the probability of a patient being the source of a cluster was proportional to the incidence rate of potential sources times the probability that a potential source would give rise to a cluster. The transmission index was defined as the average number of secondary cases of infectious tuberculosis caused directly or indirectly through recent transmission by a single potential source case and was used to estimate the effective reproductive rate associated with recent transmission, ReFAST. Among a total of 623 Dutch tuberculosis cases, 17% (95% confidence interval 9-25%) of cases were attributable to recent transmission from a non-Dutch source. The transmission index varied strongly by nationality, and was highest among the Surinamese (1.3), Moroccan (0.8), and Turkish (0.8) populations; ReFAST was 0.26. Aggregation of tuberculosis cases of given nationalities within clusters was most pronounced among recent immigrants from Somalia and (ex-)Yugoslavia. The authors conclude that differences in transmission between subpopulations can be quantified and may be used to evaluate and direct tuberculosis control.
来自结核病高流行地区的移民可能会增加欧洲结核病的发病风险。本研究旨在量化荷兰居民中不同国籍人群之间以及国籍内部的结核病传播情况。基于使用IS6110标记的限制性片段长度多态性，对1993年1月至1995年6月期间荷兰所有结核分枝杆菌分离株进行了DNA“指纹”分析。聚类被定义为具有相同指纹分离株的患者群体。假设患者成为聚类源头的概率与潜在源头的发病率乘以潜在源头引发聚类的概率成正比。传播指数被定义为单个潜在源头病例通过近期传播直接或间接导致的传染性结核病继发病例的平均数量，并用于估计与近期传播相关的有效繁殖率ReFAST。在总共623例荷兰结核病病例中，17%（95%置信区间9 - 25%）的病例归因于近期来自非荷兰源头的传播。传播指数因国籍差异很大，在苏里南人（1.3）、摩洛哥人（0.8）和土耳其人（0.8）群体中最高；ReFAST为0.26。在来自索马里和（前）南斯拉夫的近期移民中，特定国籍结核病病例在聚类中的聚集最为明显。作者得出结论，亚人群之间传播的差异可以量化，并可用于评估和指导结核病控制。
