| 摘要: | 研究目的：在台灣，結核病是通報與死亡數最多的傳染病，結核病個案的接觸者得到結核病的風險高於一般人；由於結核病接觸者檢查的研究，因資料收集的困難與程序繁複，很少有全國性及追蹤性研究；本研究是第一個利用資料庫分析台灣衛生單位執行結核病接觸者檢查結果，並追蹤接觸者三年，觀察其發病情形及探討影響發病的危險因子。
研究方法：以台灣2005年通報的16,321例確定結核病個案之35,044例接觸者為研究對象；以資料庫比對追蹤接觸者後續發病情形；危險因子探討以Cox多變項模式分析。
結果：在台灣，平均每個結核個案有3個接觸者，有93%的接觸者完成檢查；追蹤期間，有495例接觸者發病，其中有46%(229例)是在衛生單位執行接觸者檢查時找到的；接觸者第一年的結核病率最高(每十萬人口1,015人)、第二年次之(每十萬人口304人)、第三年最低(每十萬人口155人)。小於12歲兒童的結核菌感染率為26%。在Cox模式中影響接觸者發病的危險因子有年齡較大、男性、指標個案痰檢查陽性、家庭接觸者、居住山地鄉等變項。
結論：結核病接觸者檢查的成效良好，在台灣仍是很好的主動發現結核病個案的方法，但衛生單位執行的結果，應有定期評估之機制，以落實政策及瞭解執行成效。
Objective: Tuberculosis (TB) remains a leading infectious disease in Taiwan. Contacts of TB are known to be at risk of acquiring infection and developing disease. The study aimed to investigate the disease and infection rate of TB contacts, and its implication of public health policy implementation.
Method: We obtained 16,321 TB cases and 35,044 contacts from the national TB registry database since year of 2005 in Taiwan. The contact database was then matched with notification of TB for the years of 2005 to 2007, following for development of TB in contacts. Cox proportional hazard model was used to study the risk factors.
Result: An average of approximately 3 contacts was found for each TB case, and 93% of the contacts were examined. In follow up period, of 495 contacts were development of TB, among those, 46% (229 cases) contacts were diagnosed in contact investigation by health authorities. The contacts TB rate in first year is the highest 1,015/100,000；following by 304 and 155 for second to third years. 26% of children aged less than 12 years had positive TB reactions. The significant variables of predicting disease were the elder, male, infectious of index case, household contact, living in aboriginal areas in Cox proportional hazard models
Conclusion: In Taiwan, contact investigation is effective and useful for active case finding. Systematic assessment of screening program for efficacy and outcome and needed to be done for good public health practice. |
