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英语翻译
Introduction
The rapid growth of the U.S.foreign-born population poses new challenges to tuberculosis prevention.Most tuberculosis cases in this population are preventable because they result from reactivated latent tuberculosis infection (LTBI),rather than new primary infections.(1)The foreign-born account for almost 50% of tuberculosis cases in the United States,(2)and treatment of LTBI in immigrants is central to tuberculosis elimination.(3,4)
Recommended treatment for LTBI is(9)months of isoniazid,(5)but because of poor adherence and increas-ing isoniazid resistance,(6–8) shorter,rifampin-based reg-imens have been developed.In April 2000,the Ameri-can Thoracic Society and the Centers for Disease Control and Prevention (CDC) published new guide-lines for LTBI treatment that included 2 months of rifampinplus pyrazinamide (RIF/PZA) as an alternative.(5)RIF/PZA was advocated to improve adherence in mobile populations of recent immigrants,the homeless,andthe incarcerated.(5)
Soon after guideline publication,there were 23 reports of severe hepatitis from RIF/PZA,five fatal.(9,10)Revised guidelines recommend that RIF/PZA not be used as the first-line treatment for LTBI,but used only if patients are unlikely to complete a longer treatment and can be monitored with bi-weeklyliver function tests and clinical exams.(10,11)Patients must receive information about hepatotoxicity in theirnative language.(9,10)Despite potential hepatotoxicity,a recent decision analysis predicted that RIF/PZA would be more effective and less costly for tuberculosis prevention in immigrants from countries with high rates of isoniazid resistance.(12)
This article describes clinical,cultural,and economic issues that were raised by use of RIF/PZA for LTBI during an outbreak of isoniazid-resistant tuberculosis among Mexican immigrants,and addresses the following questions:What is the incidence of hepatotoxicity?Does treatment with RIF/PZA result in CDC’s target completion rate of 85%?(5)Do health departments have the resources to provide close monitoring?
Description of Outbreak
In July 2001,a 26-year-old Mexican-born male was diagnosed with isoniazid-resistant pulmonary tuberculosis in DeKalb County,Illinois.The County Health Department conducted a contact investigation and prescribed 2 months of RIF/PZA for contacts with LTBI.RIF/PZA was used because the index case was isoniazid resistant,and because the health department was concerned about adherence to 4 months of rifampin since many of the contacts worked in agriculture and were considering relocating after September.
Introduction
The rapid growth of the U.S.foreign-born population poses new challenges to tuberculosis prevention.Most tuberculosis cases in this population are preventable because they result from reactivated latent tuberculosis infection (LTBI),rather than new primary infections.(1)The foreign-born account for almost 50% of tuberculosis cases in the United States,(2)and treatment of LTBI in immigrants is central to tuberculosis elimination.(3,4)
Recommended treatment for LTBI is(9)months of isoniazid,(5)but because of poor adherence and increas-ing isoniazid resistance,(6–8) shorter,rifampin-based reg-imens have been developed.In April 2000,the Ameri-can Thoracic Society and the Centers for Disease Control and Prevention (CDC) published new guide-lines for LTBI treatment that included 2 months of rifampinplus pyrazinamide (RIF/PZA) as an alternative.(5)RIF/PZA was advocated to improve adherence in mobile populations of recent immigrants,the homeless,andthe incarcerated.(5)
Soon after guideline publication,there were 23 reports of severe hepatitis from RIF/PZA,five fatal.(9,10)Revised guidelines recommend that RIF/PZA not be used as the first-line treatment for LTBI,but used only if patients are unlikely to complete a longer treatment and can be monitored with bi-weeklyliver function tests and clinical exams.(10,11)Patients must receive information about hepatotoxicity in theirnative language.(9,10)Despite potential hepatotoxicity,a recent decision analysis predicted that RIF/PZA would be more effective and less costly for tuberculosis prevention in immigrants from countries with high rates of isoniazid resistance.(12)
This article describes clinical,cultural,and economic issues that were raised by use of RIF/PZA for LTBI during an outbreak of isoniazid-resistant tuberculosis among Mexican immigrants,and addresses the following questions:What is the incidence of hepatotoxicity?Does treatment with RIF/PZA result in CDC’s target completion rate of 85%?(5)Do health departments have the resources to provide close monitoring?
Description of Outbreak
In July 2001,a 26-year-old Mexican-born male was diagnosed with isoniazid-resistant pulmonary tuberculosis in DeKalb County,Illinois.The County Health Department conducted a contact investigation and prescribed 2 months of RIF/PZA for contacts with LTBI.RIF/PZA was used because the index case was isoniazid resistant,and because the health department was concerned about adherence to 4 months of rifampin since many of the contacts worked in agriculture and were considering relocating after September.
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