华宁县肺结核病患者发现模式和效果分析

目的为充分发挥综合医院的作用,提高结核病患者的发现率。方法通过全面推行现代结核病控制策略,实行以综合医院为中心的结核病患者归口管理和转诊工作模式,明确结核病防治机构和综合医院的职责分工,建立健全综合医院结核病患者归口管理和转诊工作制度。结果肺涂阳患者检出率由2003年的35．6％上升到2007年46．5％,增长了30．6％;涂阳新登记率由2003年的16．0／10万上升到2007年25．7／10万,上升了60．6％;综合医院结核病患者转诊率由2003年的89．6％上升到2007年的100％,上升了11．6％;结核病患者转诊、追踪总体到位率由2003年的88．6％上升到2007年的96．6％,上升了9．O％。结论利用现有医疗卫生资源和服务网络体系,推行以综合医院为中心的结核病患者归口管理及双向转诊工作制度,提高了综合医院结核病患者的转诊到位率和涂阳患者的发现率。     

结防机构与综合医院合作提高肺结核患者发现率和转诊到位率

目的探索加强结防机构与综合医院的合作,运用传染病网络报告系统,达到提高肺结核患者发现率和转诊到位率的目标。方法实施全球基金第四轮结核病控制项目,加强结防机构与综合医院合作,开展结核病网络直报、转诊和追踪管理,强化工作制度和实行奖励措施,建立医疗单位结核病网络报告、转诊和追踪的有效机制。结果新发涂阳肺结核病登记率从18.5/10万上升到实施项目后的40/10万,新发涂阳肺结核患者发现率提高了116%;转诊到位率从54%上升到66%。结论通过加强结防机构与综合医院合作,能有效提高肺结核患者发现率和转诊到位率。     

医疗机构肺结核可疑者转诊未到位的原因分析

通过因症就诊及时发现肺结核病患者,尤其是及时发现涂阳肺结核病患者,已是公认有效和可行的病例发现方式[1]。对综合医院诊断的肺结核或疑似肺结核病例采取转诊追踪措施,是确保75%结核病患者发现率的一项长期技术措施[2]。因此,     

2005-2009年内蒙古自治区结核病转诊追踪在病人发现中的作用

目的了解内蒙古自治区疑似肺结核患者转诊追踪状况和经验,总结提高结核病患者发现水平的方式。方法对内蒙古自治区2005-2009年非结防机构报告、转诊结防机构追踪情况及各年度涂阳病人发现情况进行分析。结果 2005-2009年内蒙古自治区转诊及追踪到位疑似肺结核患者,12.37%的疑似肺结核患者确诊为涂阳肺结核;占当地总涂阳患者的14.26%。结论非结防机构报告的疑似结核病患者确诊为涂阳肺结核比例呈逐年上升趋势（由2005年的4.91%上升到2009年的29.18%）,转诊追踪到位的涂阳肺结核病人占结核病患者总数的比例不断提高。加强综合医疗机构与结防机构的合作是提高肺结核病人发现的有效措施。相关卫生部门应加强督导综合医疗机构结核病转诊工作,针对转诊到位率低,各级结防机构应落实疑似结核病患者追踪工作,理顺疑似结核病患者从综合医疗机构到达结防机构获得诊疗的途径,提高肺结核患者发现水平。     

结核病网络专报系统对提高肺结核病人发现水平的分析

目的讨论通过结核病网络专报系统,综合医院转诊可疑肺结核对提高病人发现的作用。方法加强干预,规范转诊登记程序和追踪制度,实施转诊激励政策和健康促进。结果 2005-2007年内发现涂阳病人35 457例,和专报系统实施前三年比增加21 852例,增加160%,其中医院转诊发现涂阳病人13 986例,增加42.2%。转诊人数、到位人数有非常明显提高,查痰率提高了13个百分点,涂阳检出率无变化。结论利用专报系统,加强医防合作,建立完善的报告、转诊、追踪制度是提高病人发现水平的重要途径。     

综合性医院归口诊治肺结核病的改革实践

目的:充分发挥综合医院作用,提高肺结核病人发现率。方法:通过全面推行结核病控制策略(DOTS),改革防制模式,实行以一所综合医院为归口诊治、其他医院机构为归口转诊、疾控中心为归口管理模式,建立转诊制度,明确各自职责和分工。结果:全县传染源发现率平均已达96.7%;新发涂阳肺结核病新登记率从1995年~1999年30.1/10万上升到2000年~2005年44.50/10万,增长了47.8%;转诊率从1995年~1999年82.1%上升到2005年的98.5%,增长了20%。结论:改革后的结核病归口诊治管理模式,利用现有医疗资源,有效提高了肺结核病人的转诊率和涂阳病人的发现率,发挥了综合性医院对结核病控制工作的重要作用。     

2007-2013年鄢陵县涂阳肺结核病人来源及确诊情况分析

目的比较鄢陵县不同来源涂阳肺结核病人发现情况,为进一步采取措施提高涂阳肺结核病人的发现率提供科学依据。方法对2007-2013年鄢陵县不同来源涂阳肺结核病人相关资料进行分析。结果 2007-2013年鄢陵县共发现涂阳肺结核病人1439例,其中来源于因症就诊212例,占14.73%;转诊647例,占44.96%;因症推荐538例,占37.39%;其他来源42例,占2.92%。因症就诊涂阳检出率为3.68%,转诊涂阳检出率为29.42%,因症推荐涂阳检出率为20.42%,其他来源涂阳检出率为4.54%。结论涂阳肺结核病患者的发现主要靠转诊和因症推荐,二者的涂阳检出率高。卫生行政部门应加大干预力度,加强医务人员对疑似结核病患者的因症推荐与转诊;同时加强结核病防治知识的宣传,提高疑似结核病患者的就诊率。     

江西省实施FIDELIS项目病人发现成效分析

[目的]通过培训综合医院的结核病防治医生,督导综合医院肺结核病人和可疑肺结核病人的报告、查痰及转诊来提高病人发现。[方法]本项目通过培训综合医院的结核病防治医师作为督导员,加强干预,改善结核病人转诊政策和就医环境,进一步规范查痰、报告和转诊工作,同时结核病防治机构开展网络报告肺结核病人追踪工作,全面实施"医防合作",强化工作制度和实行激励措施,提高县级结核病防治人员积极性。比较干预前后情况变化,评价项目实施效果。[结果]项目实施后,转诊到位率由项目前的46.51%增加到项目后的59.35%;追踪到位率由项目前的85.39%增加到项目后的88.32%;查痰率由项目前的91.36增加到项目后的91.96%;新发涂阳病人登记率由项目前的47.73/10万增加到项目后48.78/10万,比项目前提高了2.20%。[结论]通过FIDELIS研究项目实施,我省肺结核病人转诊到位率和追踪到位率得到改善,新涂阳肺结核病人发现得到提高。     

2010—2014年天津市城区三级综合医院可疑肺结核转诊及追踪情况分析

目的分析天津市非定点结核病诊治三级综合医院2010—2014年可疑肺结核转诊及追踪情况,为提高肺结核患者发现率提供依据。方法对天津市城区三级综合医院2010—2014年可疑肺结核报告、转诊和追踪情况作描述性分析。结果 2010—2014年总体到位率、转诊到位率和追踪到位率分别从85.91%、47.34%和38.57%上升至90.98%、49.01%和41.96%;转诊到位患者中,确诊肺结核的比例和菌阳确诊率分别由2010年的44.48%和18.10%下降至2014年的32.86%和15.02%。患者转诊未到位的主要原因是回原籍治疗和其他。结论三级综合医院规范转诊可疑肺结核是提高患者发现率的有效途径,应加强医疗机构结核病报告转诊制度,提高非结核病防治机构医务人员转诊意识和结核病患者就诊主动性。     

2006-2009年米易县医疗机构疑似肺结核病转诊分析

分析米易县医疗机构疑似肺结核病患者的转诊到位确诊情况，探讨提高确诊率的措施。方法根据米易县2006-2009年结核病登记本进行分析。结果4年转诊到位677人，其中确诊涂阳肺结核病164人、涂阴36人，占全部发现活动性结核病患者的49．38％。结论米易县肺结核病患者中近一半来源于医疗机构的转诊，加大医疗机构对疑似肺结核病患者的转诊力度，有利于更好的发现患者。     

医疗机构在结核病控制工作中的作用与影响

目的分析湖南省医疗机构肺结核病例转诊和结核病防治机构进行病例追踪后诊断情况,评价医疗机构在结核病控制工作中的作用和对全省结核病控制工作的影响。方法对2005年湖南省中国结核病控制工作月报表数据进行统计,分析医疗机构转诊到位病例中,不同类型肺结核病例报告数和构成比、结核病防治机构病例追踪到位率、不同类型追踪到位病例中肺结核病例诊断情况。结果2005年全省医疗机构报告肺结核病例24145例,除去辖区外和住院病例外,转诊到结核病防治机构9534例(48.8%),其中涂阳病例转诊到位率最高,占同类病例的63.5%,菌阴病例和未痰检病例分别占同类病例的42.4%和48.2%。结核病防治机构对未到位的病例进行追踪后到位5086例,总到位率为60.6%。在追踪到位的病例中,发现涂阳病例1419例(27.9%)和菌阴病例1817例(35.7%)。追踪到位的病例中经进一步检查属于非结核排除病例为29.2%,其中医疗机构报告的未痰检病例中属于非结核排除病例占34.6%。结论做好医疗机构肺结核病例的诊断、报告和转诊工作,对全省结核病控制工作将产生很大的社会效益和经济效益。应不断加强医疗机构和结核病防治机构的合作,促进全省结核病控制工作的持续发展。     

Treatment outcomes of new adult tuberculosis patients in relation to HIV status in Zimbabwe

Setting:

All public health facilities in Chitungwiza District, Zimbabwe.

Objective:

To determine, in new tuberculosis (TB) patients registered in 2009, 1) the proportion of persons human immunodeficiency virus (HIV) tested, stratified by age, sex and type of TB, and 2) treatment outcomes in relation to type of TB and HIV status.

Design:

Retrospective cohort study.

Results:

Of 1800 TB patients, 1100 (61%) were tested, of whom 877 (80%) were HIV-positive and 75 (9%) were documented as receiving antiretroviral treatment (ART). HIV testing and HIV positivity were similar between patients with different types of TB. Overall, the treatment success rate was 70%, and 17% had transferred out. Being HIV-positive on ART was associated with better treatment success and lower transfer out; age ≥55 years was associated with poor treatment success and higher death rates. Defaulting was more common in those who did not undergo smear testing or in extra-pulmonary TB patients, while deaths were higher in males.

Conclusion:

In a Zimbabwe district, less than two thirds of TB patients were tested. Better treatment success was observed in patients documented as HIV-positive and on ART. Important lessons for improved TB control include increasing HIV testing uptake for better access to ART, more comprehensive recording practices on ART and better reporting on true outcomes of transfer-out patients.     

The trend of pulmonary tuberculosis in patients seen at DOTS clinics in the Federal Capital Territory, Abuja, Nigeria

We evaluated the pattern of sputum smear positivity and assessed the effects of directly observed treatment short course (DOTS) among tuberculosis (TB) patients at the DOTS clinics in the Federal Capital Territory (FCT), Abuja. In total, 1391 patients were seen at six microscopy and treatment centres across the FCT between January and December 2003. Their sputa were screened microscopically for the presence of acid-fast bacilli (AFB) using the Ziehl-Neelsen staining technique. In total, 296 (21.3%) patients were smear positive; 201 (67.9%) were new cases and 95 (32.1%) were follow-up cases. The highest incidence of sputum smear positivity (24.8%) was found in those aged 21-30 years and the lowest incidence (6%) was found in those aged 71 years and above. No incidence of smear positivity was recorded in children aged 0-10 years. In total, 160 of the men screened were AFB positive (75% new cases, 25% follow-up cases). In comparison, 136 women were AFB positive (59.6% new cases, 40.4% follow-up cases). During the 1-year study period, two deaths were recorded. Men pose a serious threat to public health as most of the follow-up cases result in the tubercle bacilli developing resistance to available anti-TB drugs. This study demonstrated a high prevalence of infectious TB in the population screened, and therefore underlines the need for capacity building through a multisectoral approach in the fight against the disease. Cohort analysis should be the cardinal management strategy in evaluating the effectiveness of TB control through systemic follow-up and reporting of certain indicators in treatment progress and success.     

Early detection of tuberculosis through community-based active case finding in Cambodia

ABSTRACT: BACKGROUND: : Since 2005, Cambodia's national tuberculosis programme has been conducting active case finding (ACF) with mobile radiography units, targeting household contacts of TB patients in poor and vulnerable communities in addition to routine passive case finding (PCF). This paper examines the differences in the demographic characteristics, smear grades, and treatment outcomes of pulmonary TB cases detected through both active and passive case finding to determine if ACF could contribute to early case finding, considering associated project costs for ACF. METHOD: S: Demographic characteristics, smear grades, and treatment outcomes were compared between actively (n=405) and passively (n=602) detected patients by reviewing the existing programme records (including TB registers) of 2009 and 2010. Additional analyses were performed for PCF cases detected after the ACF sessions (n=91). RESULTS: : The overall cost per case detected through ACF was US$ 108. The ACF approach detected patients from older populations (median age of 55 years) compared to PCF (median age of 48 years; p<0.001). The percentage of smear-negative TB cases detected through ACF was significantly higher (71.4%) than that of PCF (40.5%). Among smear-positive patients, lower smear grades were observed in the ACF group compared to the PCF group (p=0.002). The fairly low initial defaulter rate (21 patients, 5.2%) was observed in the ACF group. Once treatment was initiated, high treatment success rates were achieved with 96.4% in ACF and with 95.2% in PCF. After the ACF session, the smear grade of TB patients detected through routine PCF continued to be low, suggesting increased awareness and early case detection. CONCLUSIONS: : The community-based ACF in Cambodia was found to be a cost-effective activity that is likely to have additional benefits such as contribution to early case finding and detection of patients from a vulnerable age group, possibly with an extended benefit for reducing secondary cases in the community. Further investigations are required to clarify the primary benefits of ACF in early and increased case detection and to assess its secondary impact on reducing on-going transmission.     

福建省实施新型结核病防治服务体系试点探讨

目的探讨福州和厦门市实施新型结核病防治服务体系（＂三位一体＂防治模式）试点工作成效。方法分析2009-2010年10个县区肺结核患者报告登记情况,患者转诊、追踪、到位情况以及治疗队列,评价工作成效及薄弱环节。结果福州和厦门市试点活动性肺结核患者年均登记率61.62/10万和94.02/10万,其中涂阳和新涂阳登记率分别为30.81/10万、27.88/10万和37.68/10万、30.79/10万,3者均达到或超过全省同期平均水平;2个市本区域内患者转诊率97.8%、97.6%,转诊到位率15.2%、41.2%,总体到位率91.8%、96.4%（同期全省平均分别为96.7%、42.5%、92.7%）;2个市试点医院新涂阳和涂阳患者治愈率均达到90%以上。结论政策支持与经济补偿是顺利实施新型结核病防治服务体系建设的重要前提。     

Using tuberculosis patient characteristics to predict future cases with matching genotype results

Setting: United States.Background: It is unknown whether tuberculosis (TB) case or patient characteristics can predict the likelihood of future related TB cases.Objective: To estimate the likelihood for future related cases, i.e., cases with matching TB genotypes within the same county diagnosed within the 2 years following the year of reporting of each included case.Design: We considered all TB cases with genotyping results reported in the United States during 2004–2010. Predictive scores were calculated based on patient characteristics by dividing the number of patients who were not the last case in a county-level TB genotype cluster by the total number of patients.Results: Overall, there was a 30.8% chance that a future related case would be detected during the 2 years following the report year of any given case. Future related cases were detected in 34.7% of instances following the diagnosis of smear-positive cases, 51.9% of instances following the diagnosis of a homeless patient and 45.2% of instances following the diagnosis of a patient who reported substance abuse. Predictive scores ranged by race (White 13.9%, Native Hawaiian 43.8%) and age group (⩾65 years 13.1%, 0–4 years 43%), and were higher for US-born patients.Conclusions: Behavioral and sociodemographic factors can help predict the likelihood of future related cases and can be used to prioritize contact investigations.     

Epidemiological trend in tuberculosis in the Italian region of Liguria: impact of immigration and AIDS

BACKGROUND: Tuberculosis (TB) uniformly decreased in all industrialized countries from 1950 to 1985. However, since 1985 an upsurge of the disease has been observed, probably due to the increases in AIDS and immigration. It is for this reason that in the last decade all industrialized countries have intensified their controls on TB and a new reduction has been recently observed. METHODS: In this study we collected epidemiological data (mortalities and reported cases) for the region of Liguria over the last 15 years. We then calculated the incidence rate of TB per 100,000 residents according to age, HIV infection and nationality, making a distinction between European Union (EU) citizens and immigrants coming from countries outside the EU. RESULTS: The rate of mortality, after the last peak at the end of the Second World War, has progressively decreased from 1946 to today, so much so that presently we record fewer than two cases per 100,000 people. We observed a consistent downward trend in the incidence rate up to 1987, but from 1988 onwards this trend stopped and, in subsequent years, we detected an increase in the incidence rate, which peaked in 1996. This led to increased interventions, which has resulted in a considerably decreased overall rate of cases of TB during the last few years. The number of TB cases specifically among foreigners increased considerably during the last 5 years, whereas there was a drastic reduction in the number of total TB cases, as well as an interesting reduction in AIDS cases. During the same period there was a progressive decrease in tuberculin skin positivity in all school classes. CONCLUSIONS: The reduction in TB notifications is probably due to an increase in surveillance and control of social and health conditions. These results show that immigrant workers are considered to be a high-risk group, whereas the risk has progressively decreased in the HIV group.     

浙江省儿童肺结核疫情现状分析

目的 了解浙江省儿童肺结核疫情现状,为加强儿童肺结核病的防控措施提供依据。方法 检索2008-2014年中国疾病预防控制系统中的传染病报告信息管理系统和结核病信息管理系统,获取0~14岁儿童肺结核病的报告发病、登记及治疗管理数据,并进行描述性统计分析。结果 2008-2014年浙江省共报告0~14岁儿童活动性肺结核1 338例（菌阳儿童肺结核345例）,其中登记、治疗的有981例,占报告数量的73.3%。0~14岁儿童肺结核年均报告发病率为2.3/10 万,其中菌阳病例年均报告发病率为0.6/10 万。0~14岁儿童肺结核报告发病率波动中有所下降,菌阳肺结核的报告发病率波动中有所上升。结论 儿童肺结核防控工作仍需要继续加大投入,有效的开展健康促进工作,提高发现治疗和管理水平,进一步降低儿童肺结核病的疫情。     

HIV and tuberculosis in Ho Chi Minh City, Vietnam, 1997-2002

In Ho Chi Minh City, Vietnam, reporting rates for tuberculosis (TB) are rising in an emerging HIV epidemic. To describe the HIV epidemic among TB patients and quantify its impact on rates of reported TB, we performed a repeated cross-sectional survey from 1997 through 2002 in a randomly selected sample of inner city TB patients. We assessed effect by adjusting TB case reporting rates by the fraction of TB cases attributable to HIV infection. HIV prevalence in TB patients rose exponentially from 1.5% to 9.0% during the study period. Young (<35 years), single, male patients were mostly affected; injection drug use was a potent risk factor. After correction for HIV infection, the trend in TB reporting rates changed from a 1.9% increase to a 0.4% decrease per year. An emerging HIV epidemic, concentrated in young, male, injection drug users, is responsible for increased TB reporting rates in urban Vietnam.     

Exploring the effects of BCG vaccination in patients diagnosed with tuberculosis: Observational study using the Enhanced Tuberculosis Surveillance system

BackgroundBacillus Calmette–Guérin (BCG) is one of the most widely-used vaccines worldwide. BCG primarily reduces the progression from infection to disease, however there is evidence that BCG may provide additional benefits. We aimed to investigate whether there is evidence in routinely-collected surveillance data that BCG vaccination impacts outcomes for tuberculosis (TB) cases in England.MethodsWe obtained all TB notifications for 2009–2015 in England from the Enhanced Tuberculosis surveillance system. We considered five outcomes: All-cause mortality, death due to TB (in those who died), recurrent TB, pulmonary disease, and sputum smear status. We used logistic regression, with complete case analysis, to investigate each outcome with BCG vaccination, years since vaccination and age at vaccination, adjusting for potential confounders. All analyses were repeated using multiply imputed data.ResultsWe found evidence of an association between BCG vaccination and reduced all-cause mortality (aOR:0.76 (95%CI 0.64–0.89), P:0.001) and weak evidence of an association with reduced recurrent TB (aOR:0.90 (95%CI 0.81–1.00), P:0.056). Analyses using multiple imputation suggested that the benefits of vaccination for all-cause mortality were reduced after 10 years.ConclusionsWe found that BCG vaccination was associated with reduced all-cause mortality in people with TB although this benefit was less pronounced more than 10 years after vaccination. There was weak evidence of an association with reduced recurrent TB.