請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/78384
標題: | 臺灣新住民和結核病:辨識潛伏結核感染篩檢之高風險族群 New immigrant and tuberculosis in Taiwan:Identify high-risk groups that screen for latent TB infection. |
作者: | Pei-Ling Chen 陳佩伶 |
指導教授: | 方啟泰(Chi-Tai Fang) |
關鍵字: | 新住民,移民,外籍配偶,結核病,潛伏結核感染, new immigrant,immigrant,foreign spouse,tuberculosis (TB),latent tuberculosis infection (LTBI), |
出版年 : | 2021 |
學位: | 碩士 |
摘要: | 背景及目標 文獻研究顯示高收入國家結核病個案的分布,多呈現本國個案持續下降或維持很低的發生率,但外國出生者(foreign-born)的結核病(Tuberculosis ; TB)發生率卻呈上升或維持高於本國個案;在部分結核病發生率低的先進國家甚至可明顯看到,來自結核病高負擔國家的移民有比較高的結核病發生率、死亡率及潛伏結核感染(latent TB infection ; LTBI)率。由於結核病為空氣傳染疾病,只要有傳染性結核病個案,不論本國或外國籍,只要頻繁接觸就可能被感染,因此如何自這些移民人口中,找出結核病患者是非常重要的工作。目前國際上有常見的方法有二種,分別為在到達欲移民國家前或到達後檢查是否罹患活動性肺結核;其次是針對來自世界衛生組織(World Health Organization ; WHO)公布之結核病高負擔國家的移民進行LTBI篩檢並提供預防性治療。 我國新住民在臺人數於2016年達到52萬人次,主要來自大陸地區,其次為越南與印尼籍,而這些國家均屬WHO公布之結核病高負擔國家。LTBI治療已被證實為極具成本效益為可有效避免潛伏結核感染者發病為結核病之策略,目前也是WHO主推實現結核病發病率趨近於百萬分之一之消除目標的重要策略。因此,本研究除了解國內新住民結核病之發生情形,並分析新住民LTBI篩檢陽性率,作為評估是否將LTBI篩檢納入現行新住民入籍與體檢規範調整之參考。 研究方法 一、新住民結核病發病情形分析 利用疾管署結核病資料庫與內政部移民署(下稱移民署)出入境管理系統資料,針對2006-2016年1,305名新通報結核病確診新住民之原國籍、首次來申請居留證日期等變項進行比對,排除資料不完整243人,最後納入發生比例計算之新住民個案數為1,062人,以及2006-2016年之本國籍15-49歲之育齡女性結核病個案13,435人。計算結核病發生比率,並以卡方檢定性別、年齡、傳染力及抗藥情形在不同國籍別新住民與育齡女性之本國籍個案間的差異。 二、新住民結核病接觸者潛伏結核感染情況分析 以結核病資料庫中2016年1月至2020年6月通報確診個案之15-49歲58,047名身分別與性別完整建檔之育齡女性接觸者(本國籍接觸者39,574名,新住民接觸者388名),進行IGRA檢驗結果分析。為瞭解接觸者IGRA檢驗結果是否為因與指標為共同居住者或職場接觸者而有不同,因此將接觸者依指標個案的情況(共同居住者或職場接觸者),以邏輯斯回歸分析影響接觸者IGRA檢驗結果的影響因子。納入分析的因子包括:接觸者身分別(本國籍、新住民)、接觸者年齡、指標個案性別、指標個案年齡、指標個案初查痰塗片結果、指標個案初查NAA結果、指標個案胸部X光結果、指標個案是否為MDR。 三、所有的資料分析使用Excel及SAS9.4版軟體,以雙尾檢定p值小於0.05視為有統計上顯著差異。 研究結果 本研究結果顯示,來臺後確診為結核病的新住民約有94%為育齡女性,40%-50%個案的初查痰結果為高傳染力(S+C+MTBC)及中傳染力(S-C+MTBC),其中又以原國籍為泰國及中國大陸之新住民,初查痰傳染力較強者佔50%以上。此外,新住民育齡女性結核病確診個案,其中高傳染力(S+C+MTBC)及中傳染力(S-C+MTBC)佔比46.89%與本國籍個案之44.67%相似。新住民育齡女性結核病確診個案之MDR/XDR-TB情形,為本國籍育齡女性結核病確診個案2倍(0.62 vs 1.50),其中有12名中國大陸籍與3名越南籍之新住民,來臺後診斷為MDR-TB,1名中國大陸籍新住民診斷為XDR-TB,另約有60%的新住民於申請居留5年內通報確診為結核病。在LTBI盛行率方面,與指標個案為同住關係之育齡女性「新住民」接觸者,IGRA陽性的風險顯著高於「本國籍」女性(OR:2.28;95CI%:1.720-3.021);與指標個案為職場接觸關係之育齡女性「新住民」接觸者,IGRA陽性的風險也顯著高於「本國籍」女性(OR:5.149;95CI%:3.567-7.434)。 研究結論 本研究結果顯示,相較於同年齡(15-49歲)本國籍女性,新住民女性LTBI盛行率較高。發展為結核病個案,新住民有二倍機率為MDR-TB,特別是來自中國大陸及越南籍之配偶。因此,建議未來可思考來臺後之新住民,縮短提供胸部X光檢查時間,以及早診斷提供治療,阻斷傳播。亦可思考參考WHO建議,針對來自結核病發生高負擔國家之新住民,提供潛伏結核感染篩檢與預防性治療服務,避免日後發病。 Background and goals Based on the literature review, the distribution of tuberculosis cases in high-income countries mostly shows a continuous decline in domestic cases or maintain a low incidence rate. However, the incidence of tuberculosis (TB) in foreign-born people has increased or remained higher than domestic cases. In some advanced countries with a low incidence of TB, it is even clear to recognize that immigrants from a high burden of TB countries have a relatively higher incidence, mortality, and latent TB infection (LTBI) rate. Due to TB is an airborne disease, as long as there are infectious cases, people may infect by TB with frequent contact. Regardless of Taiwan citizen or foreigner. Therefore, it is crucial to recognize those TB patients from these immigrant populations. There are two common methods use worldwide, one is to check whether there is an active TB before or after arriving in the country where you want to immigrate; the other one is to screen for the LTBI status and provide preventative treatment to the immigrants who are from a high burden of TB countries announced by World Health Organization (WHO). The number of new-immigrants in Taiwan reached 520,000 people in 2016. Most of the new-immigrants are from China, followed by Vietnam and Indonesia. These countries are recognized as high burden of TB countries by WHO. LTBI treatment has been proven to be a cost-effective strategy that can effectively prevent latent tuberculosis infection from becoming active tuberculosis. It is also an important strategy recommended by WHO to achieve the elimination target of TB incidence rate approaching one in one million. Therefore, to understand the incidence of TB among new-immigrants in Taiwan. This study also analyzes the positive rate of LTBI screening for new-immigrants, as a reference for evaluating to see if LTBI screening should be included in the current new immigrants’ naturalization and physical examination regulations. Methods I. Analyze the incidence of TB among new immigrants This study is going to utilize the TB database of Taiwan Centers for Disease Control and immigration management system of the Immigration Department of the Ministry of the Interior (hereafter referred as Immigration Department). Compared the 1,305 cases between 2006 and 2016 that were newly notified as confirmed TB as new-immigrants with original nationality, and the date of the very first time apply for the residence permit, etc. For comparison, there are 243 people were excluded with incomplete information. The final number of new-immigrants included in the calculation of the occurrence ratio was 1,062, and 13,435 cases of tuberculosis in females of childbearing age between 15-49 years old of Taiwanese from 2006 to 2016. To calculate the incidence of tuberculosis, and use the chi-square test to determine the differences in gender, age, infectious, and drug resistance between new-immigrants of different nationalities and females of childbearing age. II. Analysis of latent tuberculosis infection among new-immigrants who are recognized as contacts. The 58,047 females of childbearing age between 15-49 years old contacts (39,574 contacts of Taiwanese and 388 contacts of new immigrants) who were in the TB database from 2016 to June 2020 with complete identity and gender information were analyzed for the results of the IGRA test. To understand whether the results of the IGRA test of the contacts are different from the indicators of cohabitant or colleague, the contacts are analyzed based on the status of the indicators (cohabitant or colleague contacts). Also, this study analyzed the impact factors of contacts’ IGRA results with logistic regression. Factors included in the analysis are contact’s identity (Taiwanese or new immigrants), the gender of contact, age of contact, the gender of the index case, sputum smear result and NAA result in the initial examination of the index case, chest X-ray’s outcome of the index case, and whether the index case is multidrug-resistant tuberculosis (MDR). III. The data analysis uses Excel or SAS 9.4 version with two-tailed test and p-value less than 0.05 as a statistically significant difference. Result The result shows 94% of confirmed cases among new-immigrants are childbearing women, and about 40% to 50% of new-immigrants diagnosed with sputum smear as high infectivity tuberculosis (S+C+MTBC) and moderate infectivity tuberculosis (S-C+MTBC) in the initial examination after came to Taiwan. New-immigrants with their original nationalities as Thailand or China have more than 50% as high and moderate infectivity TB. 46.89% of confirmed cases with high and moderate infectivity TB among childbearing age new-immigrants female is similar to 44.67% of confirmed cases with citizenship. The MDR/XDR-TB status of confirmed TB cases in women of childbearing age among new-immigrants was twice as much as that of confirmed tuberculosis cases in women of childbearing age (0.62 v. 1.50). Among them, 12 new-immigrants of China and three new-immigrants of Vietnam were diagnosed with MDR-TB after coming to Taiwan, and one new resident of China was diagnosed with XDR-TB. 60% of new-immigrants reported confirmed TB within 5 years after applying for the residence permit. In terms of the prevalence of LTBI, the contact of new-immigrants as indicator’s cohabitant has a higher risk to have IGRA-positive than Taiwanese (OR:2.28;95CI%:1.720-3.021); the contacts of new-immigrants as indicator’s colleague also has a higher possibility to have IGRA-positive than Taiwanese (OR:5.149;95CI%:3.567-7.434). Conclusion According to the result of this study, compared to the women of the same age (15-49 years old) with citizenship, the prevalence of LTBI among new-immigrant women is higher. For the development of tuberculosis cases, new-immigrants have a double chance of MDR-TB. Especially spouses from mainland China or Vietnam. Therefore, this study recommends that new-immigrants should shorten the interval between the provisions of chest X-ray examinations after coming to Taiwan and provide early diagnosis and treatment to prevent transmission. Furthermore, we can consider whether to refer to the WHO recommendations to provide latent tuberculosis infection screening and preventive treatment services for new-immigrant from countries with a high burden of tuberculosis to avoid future disease. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/78384 |
DOI: | 10.6342/NTU202100238 |
全文授權: | 有償授權 |
顯示於系所單位: | 公共衛生碩士學位學程 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
U0001-2801202119205800.pdf 目前未授權公開取用 | 4.82 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。