RESUMO
SETTING: The Rotterdam region, the Netherlands, 1995-2006. OBJECTIVE: To identify factors associated with the high tuberculosis (TB) case rate in an urban area. DESIGN: Municipalities were divided into urban and semi-urban/rural municipalities. We compared the characteristics of TB cases and stratified case rates according to age group, immigrant status and place and time of infection between the two areas. RESULTS: The TB case rate in urban municipalities was 3.8-fold higher than in semi-urban/rural municipalities. After stratification for country of birth, the rate ratios were lower (1.7 for immigrants and 2.8 for non-immigrants). Immigrants had most frequently acquired their infection abroad (47% of urban and 62% of semi-urban/rural immigrant cases). In 40% of urban cases and 27% of semi-urban/rural cases, the infection was recently acquired in the Netherlands, translating into a 5.7-fold higher recent transmission case rate for the urban population. CONCLUSIONS: The high urban TB case rate was related to the high proportion of urban immigrants who frequently reactivated an infection acquired abroad. Recent transmission also contributed to a substantial part of the TB caseload in urban municipalities among both urban immigrants and non-immigrants. The authors propose a package of targeted interventions to address the identified factors associated with the high urban TB case rate.
Assuntos
Saúde da População Rural/estatística & dados numéricos , Tuberculose/epidemiologia , Saúde da População Urbana/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Impressões Digitais de DNA , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Fatores de Risco , Fatores de Tempo , Tuberculose/etiologia , Tuberculose/transmissão , Adulto JovemRESUMO
We conducted a population-based study in the Rotterdam region of The Netherlands to determine the place and time of infection of tuberculosis (TB) cases using conventional epidemiological and genotyping information. In particular, we focused on the extent of misclassification if genotyping was not combined with epidemiological information. Cases were divided into those with a unique mycobacterial DNA fingerprint, a clustering fingerprint, and an unknown fingerprint. We developed transmission classification trees for each category to determine whether patients were infected in a foreign country or recently (
Assuntos
Técnicas de Tipagem Bacteriana , Busca de Comunicante , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Tuberculose/transmissão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Análise por Conglomerados , Impressões Digitais de DNA , DNA Bacteriano/genética , Feminino , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Países Baixos , População UrbanaRESUMO
The aim of this study was to describe a systematic process of record-linkage, cross-validation, case-ascertainment and capture-recapture analysis to assess the quality of tuberculosis registers and to estimate the completeness of notification of incident tuberculosis cases in The Netherlands in 1998. After record-linkage and cross-validation 1499 tuberculosis patients were identified, of whom 1298 were notified, resulting in an observed under-notification of 13.4%. After adjustment for possible imperfect record-linkage and remaining false-positive hospital cases observed under-notification was 7.3%. Log-linear capture-recapture analysis initially estimated a total number of 2053 (95% CI 1871-2443) tuberculosis cases, resulting in an estimated under-notification of 36.8%. After adjustment for possible imperfect record-linkage and remaining false-positive hospital cases various capture-recapture models estimated under-notification at 13.6%. One of the reasons for the higher than expected estimated under-notification in a country with a well-organized system of tuberculosis control might be that some tuberculosis cases, e.g. extrapulmonary tuberculosis, are managed by clinicians less familiar with notification of infectious diseases. This study demonstrates the possible impact of violation of assumptions underlying capture-recapture analysis, especially the perfect record-linkage, perfect positive predictive value and absent three-way interaction assumptions.