Chin D P, DeRiemer K, Small P M, de Leon A P, Steinhart R, Schecter G F, Daley C L, Moss A R, Paz E A, Jasmer R M, Agasino C B, Hopewell P C
Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital Medical Center, San Francisco General Hospital, Medicine, University of California, San Francisco, CA, USA.
Am J Respir Crit Care Med. 1998 Dec;158(6):1797-803. doi: 10.1164/ajrccm.158.6.9804029.
To determine the factors contributing to tuberculosis incidence in the U.S.-born and foreign-born populations in San Francisco, California, and to assess the effectiveness of tuberculosis control efforts in these populations, we performed a population-based molecular epidemiologic study using 367 patients with strains of Mycobacterium tuberculosis recently introduced into the city. IS6110-based and PGRS-based restriction fragment length polymorphism (RFLP) analyses were performed on M. tuberculosis isolates. Patients whose isolates had identical RFLP patterns were considered a cluster. Review of public health and medical records, plus patient interviews, were used to determine the likelihood of transmission between clustered patients. None of the 252 foreign-born cases was recently infected (within 2 yr) in the city. Nineteen (17%) of 115 U. S.-born cases occurred after recent infection in the city; only two were infected by a foreign-born patient. Disease from recent infection in the city involved either a source or a secondary case with human immunodeficiency virus (HIV) infection, homelessness, or drug abuse. Failure to identify contacts accounted for the majority of secondary cases. In San Francisco, disease from recent transmission of M. tuberculosis has been virtually eliminated from the foreign-born but not from the U.S.-born population. An intensification of contact tracing and screening activities among HIV-infected, homeless, and drug-abusing persons is needed to further control tuberculosis in the U.S.-born population. Elimination of tuberculosis in both the foreign-born and the U.S. -born populations will require widespread use of preventive therapy.
为确定促成加利福尼亚州旧金山市美国出生和外国出生人群结核病发病率的因素，并评估针对这些人群结核病防控工作的有效性，我们开展了一项基于人群的分子流行病学研究，纳入了367例近期将结核分枝杆菌菌株传入该市的患者。对结核分枝杆菌分离株进行了基于IS6110和基于PGRS的限制性片段长度多态性（RFLP）分析。分离株RFLP模式相同的患者被视为一个聚集性病例组。通过查阅公共卫生和医疗记录以及对患者进行访谈，来确定聚集性病例组患者之间传播的可能性。252例外国出生病例中无一例是近期（2年内）在该市感染的。115例美国出生病例中有19例（17%）是近期在该市感染后发病的；仅有2例是被外国出生的患者感染。该市近期感染所致疾病涉及一名传染源或一名合并人类免疫缺陷病毒（HIV）感染、无家可归或药物滥用情况的二代病例。未识别出接触者占二代病例的大多数。在旧金山，外国出生人群中结核分枝杆菌近期传播所致疾病实际上已消除，但美国出生人群中并非如此。需要加强对HIV感染者、无家可归者和药物滥用者的接触者追踪和筛查活动，以进一步控制美国出生人群中的结核病。要在外国出生和美国出生人群中消除结核病，需要广泛使用预防性治疗。
