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題 名 | 校園結核病聚集事件風險因子分析=Risk Factors for School Tuberculosis Outbreaks |
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作 者 | 朱柏威; 鄭人豪; 許建邦; 李品慧; 陳昶勳; | 書刊名 | 疫情報導 |
卷 期 | 32:6 2016.03.22[民105.03.22] |
頁 次 | 頁134-141 |
分類號 | 412.452 |
關鍵詞 | 結核病; 聚集感染事件; 校園; 病例對照研究; 風險評估; Tuberculosis; Outbreak; Case-control study; Risk assessment; |
語 文 | 中文(Chinese) |
中文摘要 | 本文章以病例對照研究(case-control study)設計,回溯性分析疾病管制署2011年至2013年間通報之疑似校園聚集事件,並依據結核病資料庫之疫情調查資料、個案通報時疾病情形等,評估疑似事件發展為確定事件之風險因子。研究期間共通報95件校園事件,包括確定事件24件及非確定事件71件。病例對照研究發現,確定事件的風險因子包含指標個案為痰塗片陽性(OR 4.67, 95% CI 1.19–28.25)、或有延後就醫情形(出現疑似結核病症狀逾6個月)(OR 13.17, 95% CI 1.53–113.06)、事件第二案為指標個案接觸者發病(OR 11.153, 95% CI 2.58–48.28);另外,指標個案性別為女性為確定事件的保護因子(OR 0.19, 95% CI 0.05–0.75)。單變項分析亦發現當機構內接觸者結核菌素測驗(tuberculin skintest,簡稱TST)陽性率大於50%時,確定事件風險較高(OR 5.33 , 95% CI 1.17–24.28)。當校園事件出現指標個案為痰塗片陽性、或有延後就醫情形(出現疑似結核病症狀逾6個月)、或機構內TST陽性率大於50%、或事件第二案為指標個案接觸者發病等任一情形時,衛生人員於取得菌株比對結果以前,即可考慮儘早啟動防疫作為:例如強化接觸者調查、重新評估須進行潛伏結核感染(latent tuberculosis infection, LTBI)治療對象或調查該機構通風條件與建議改善措施。 |
英文摘要 | This report described results from a case-control study involving 95 suspected tuberculosis (TB) outbreaks reported during 2011–2013. A confirmed outbreak was defined as a cluster with at least two TB patients having matched genotypes of Mycobacterium tuberculosis. Patient demographics, epidemiologic links, and clinical characteristics were extracted from National TB surveillance system and outbreak investigation reports. We used logistic regression to describe risk factors of being confirmed as an outbreak. Twenty four (25.3%) of the 95 suspected events were confirmed outbreaks. Suspected events were most likely to become outbreaks if the index patient was sputum smear positive (OR 4.67, 95% CI 1.19–28.25); the index patient was with delayed medical care (symptomatic or with abnormal chest radiography for more than six months before TB notification) (OR 13.17, 95% CI 1.53–113.06); or a second patient in the event was a contact of the index patient (OR 11.153, 95% CI 2.58–48.28). Events with a female index patient was less likely to become an outbreak (OR 0.19, 95% CI 0.05–0.75). We recommend review of routinely reported data to identify high-risk school events that are likely to be confirmed outbreaks. For these events, public health officials should implement interventions before the genotyping results are available. |
本系統中英文摘要資訊取自各篇刊載內容。