TB reactivation rates about 0.07-0.099 per 100 person-years

1950年代做的data是 0.10-0.16 per 100 person-years, which justified LTBI tx
但目前只有0.070-0.099 per 100 person-years, 排除掉HIV病人還更降到0.040-0.058 per 100 person-years, 那我們還做LTBI tx 幹啥?

類似的觀念蘇維鈞主任有講過，台灣似乎花太多資源在LTBI上面，沒有data support LTBI tx 的功效. 應該先有類似baseline data，再說服臨床院所加入LTBI tx

台灣目前的階段，應該還是先抓出病人，治好病人，阻斷感染源為先…特別是越來越沒錢的時候…



How Common Is Reactivation Tuberculosis?

In a population-based tuberculin skin-test survey, the rate of reactivation TB was 0.070 to 0.099 per 100 person-years.

Active tuberculosis (TB) results from recent acquisition of Mycobacterium tuberculosis or, more commonly in the U.S., from reactivation of latent TB infection (LTBI). Knowing the current rate of reactivation TB is important in the drive to implement preventive strategies. The rate was last calculated in the 1950s, when it was found to be 0.10 to 0.16 per 100 person-years. Since then, the epidemiology and management of TB have changed substantially.

To calculate today's rate, researchers performed a population-based tuberculin skin-test survey among randomly selected residents in western Palm Beach County, Florida, between January 1998 and October 2000. The calculations were done using two methods: In the "n" method, all unclustered cases of active TB were included in the numerator; in the "n–1" method, the first case in each cluster was added to the unclustered cases.

Among the 447 residents who were enrolled, 135 (30%) were determined to have LTBI. The overall rate of reactivation per 100 person-years was 0.070 using the "n" method and 0.099 using the "n–1" method. These rates dropped to 0.040 and 0.058, respectively, when HIV-infected individuals were excluded.

Comment: These data, although derived from a relatively small cohort, highlight the effect of HIV infection on the rate of reactivation TB; they also reveal an overall decline in that rate since the 1950s. As the authors note, today's lower rate can probably be explained by a decreased prevalence of old, untreated, but spontaneously healed TB.

— Neil M. Ampel, MD

Published in Journal Watch Infectious Diseases August 25, 2010
Citation(s):

Horsburgh CR Jr et al. Revisiting rates of reactivation tuberculosis: A population-based approach. Am J Respir Crit Care Med 2010 Aug 1; 182:420.

* Original article (Subscription may be required)
* Medline abstract (Free)

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即便是用IGRA, 有時也要等大於三個月才能決定TB contact

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