RESUMO
BACKGROUND AND OBJECTIVE: To describe trends and epidemiological characteristics of immigrant and native populations with tuberculosis. POPULATION AND METHOD: Population-based, descriptive analysis of case data reported to the Regional Registry of Tuberculosis Cases from 1994 to 2003 living in the south of Madrid, Spain (755,202 inhabitants). RESULTS: The number of cases reported was 2211, of which 269 (12.1%) were foreign-born persons. Tuberculosis incidence declined from 46.6/100,000 in 1994 (2.9% immigrants) to 25.2/100,000 in 2003 (35.8% immigrants) (p < 0.001). Foreign-born persons with tuberculosis had come to Spain from Latin America-Caribbean (56%), Africa (30%) and Europe (11%). Of the foreign-born, 73.6% developed active tuberculosis within 5 years of arrival (50.9% within 2 years). CONCLUSIONS: The incidence of tuberculosis has declined in the study area but the tendency to decrease has come to a halt because of cases occurring among immigrants. Among those for whom the date of Spain entry was known, a half arrived 2 years or less prior to the diagnosis of tuberculosis. We stress that tuberculosis control programs must target such at-risk population.
Assuntos
Emigração e Imigração/estatística & dados numéricos , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Área Programática de Saúde , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Espanha/epidemiologia , População UrbanaRESUMO
Fundamento y objetivo: El objetivo de este estudio es cuantificar el aumento de tuberculosis importada y comparar las características clinicoepidemiológicas entre inmigrantes y autóctonos. Población y método: Estudio descriptivo poblacional de casos diagnosticados en Madrid (Área 11, 755.202 habitantes), en el período 1994-2003. La fuente de datos utilizada fue el Registro Regional de Casos de Tuberculosis. Resultados: Se notificaron 2.211 casos, 269 (12,1%) correspondían a inmigrantes. La tasa de incidencia pasó de 46,6/100.000 en 1994 (2,9% inmigrantes) a 25,2/100.000 en 2003 (35,8% inmigrantes) (p < 0,001). Los inmigrantes procedían de América Latina-Caribe (56%), África (30%) y Europa (11%). El 73,6% desarrolló tuberculosis en el primer quinquenio de estancia (un 50,9% en el primer bienio). Conclusiones: Se evidencia una tendencia decreciente en la incidencia global de tuberculosis, con disminución en la población autóctona y aumento en la población inmigrante. La mitad de los pacientes inmigrantes enferman en los 2 primeros años
Background and objective: To describe trends and epidemiological characteristics of immigrant and native populations with tuberculosis. Population and method: Population-based, descriptive analysis of case data reported to the Regional Registry of Tuberculosis Cases from 1994 to 2003 living in the south of Madrid, Spain (755,202 inhabitants). Results: The number of cases reported was 2211, of which 269 (12.1%) were foreign-born persons. Tuberculosis incidence declined from 46.6/100,000 in 1994 (2.9% immigrants) to 25.2/100,000 in 2003 (35.8% immigrants) (p < 0,001). Foreign-born persons with tuberculosis had come to Spain from Latin America-Caribbean (56%), Africa (30%) and Europe (11%). Of the foreign-born, 73.6% developed active tuberculosis within 5 years of arrival (50.9% within 2 years). Conclusions: The incidence of tuberculosis has declined in the study area but the tendency to decrease has come to a halt because of cases occurring among immigrants. Among those for whom the date of Spain entry was known, a half arrived 2 years or less prior to the diagnosis of tuberculosis. We stress that tuberculosis control programs must target such at-risk population
Assuntos
Humanos , Tuberculose/epidemiologia , Emigração e Imigração/estatística & dados numéricos , Epidemiologia Descritiva , Grupos Populacionais/estatística & dados numéricosRESUMO
BACKGROUND: Employing molecular epidemiology techniques for the study of tuberculosis can afford the possibility of identifying tuberculosis transmission patterns. This study has been made for the purpose of estimating the incidence of tuberculosis related to recent transmission in Madrid and of identifying the risk factors making it possible to define transmission patterns. METHODS: A three-year descriptive populational study was conducted on patients diagnosed with tuberculosis based on cultures in four districts in Madrid (550,442 inhabitants). The transmission patterns were described by means of conventional epidemiological research and molecular techniques (Restriction Fragment Length Polymorphism--RFLP--analysis with IS6110 and spoligotyping). RESULTS: An RFLP analysis was conducted on 233 clinically isolated Mycobacterium tuberculosis strains, 99 (42.5%) of which were grouped into 29 clusters. The most numerous group was comprised of 134 patients infected with M. tuberculosis strains of a single RFLP pattern. These patients averaged 48.3 years of age (DE 19.4), and 17.2% were revealed to have an endogenous risk factor. Two transmission patterns were identified among the grouped cases. The first pattern included 57 patients pertaining to 23 small clusters (2-4 cases), 25 (43.9%) of which were epidemiologically linked to another case from the same cluster. The second pattern was comprised of 42 patients grouped into 6 large clusters (5 cases or more). The subjects averaged 31.4 years of age (DE 15.8), 28.6% being intravenous drug users, 31% infected with HIV, and 26.2% having a prison background. CONCLUSIONS: Identifying tuberculosis transmission patterns by using molecular biology techniques affords the possibility of detecting population groups for whom preferential measures can be taken in the prevention and control programs.
Assuntos
Tuberculose/transmissão , Adulto , Área Programática de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Análise Multivariada , Mycobacterium tuberculosis/genética , Polimorfismo de Fragmento de Restrição , Estudos Prospectivos , Espanha , Tuberculose/microbiologia , Saúde da População UrbanaRESUMO
Fundamento: La aplicación de las técnicas de epidemiología molecular en el estudio de la tuberculosis puede permitir identificar los patrones de transmisión de la enfermedad. El objetivo de este estudio ha sido estimar la incidencia de tuberculosis asociada a transmisión reciente en Madrid e identificar los factores de riesgo que permitan definir patrones de transmisión. Métodos: Se realizó un estudio descriptivo poblacional de tres años de duración en pacientes diagnosticados de tuberculosis mediante cultivo en cuatro distritos de Madrid (550.442 habitantes).La descripción de los patrones de transmisión se realizó mediante la investigación epidemiológica convencional y las técnicas moleculares (análisis de fragmentos de restricción de longitud polimórfica -RFLP- con IS6110 y spoligotyping). Resultados: Se realizó RFLP en 233 aislados clínicos de Mycobacterium tuberculosis, de los que 99 (42,5 por ciento) estaban agrupados en 29 clusters. El grupo más numeroso lo formaban 134 enfermos infectados por cepas de M. tuberculosis con patrón RFLP único. Su media de edad era 48,3 años (DE 19,4) y el 17,2 por ciento presentaba un factor de riesgo de reactivación endógena. Entre los casos agrupados se identificaron dos patrones de transmisión. El primero de ellos incluía a 57 enfermos pertenecientes a 23 clusters pequeños (2-4 casos), de los que 25 (43,9 por ciento) estaban conectados epidemiológicamente con otro caso de su mismo cluster. El segundo lo formaban 42 pacientes agrupados en 6 clusters grandes (5 casos o más). La media de edad era de 31,4 años (DE 15,8), el 28,6 por ciento eran usuarios de drogas inyectadas, el 31 por ciento estaban infectados por el VIH, y el 26,2 por ciento tenían antecedentes de estancia en prisión. Conclusiones: La identificación de patrones de transmisión de la tuberculosis utilizando técnicas de biología molecular permite detectar grupos de población susceptibles de actuación preferente en los programas de prevención y control (AU)
