結核病的預防和控制策略－－試以長期照護機構為例

Strategy for the Prevention and Control of Tuberculosis: Importance for Long-term Care Facilities

結核病目前在台灣仍佔法定傳染病死亡及發生率的第一位，但由於潛伏期長、病徵無專一性、疾病演變緩慢，再加上受限的實驗室檢查敏感度和時效，臨床上容易遭受忽略。而護理之家的工作人員及住民多屬結核病傅染及發病的危險族群，因此如何在護理之家這種長期照顧機構建立對傅染性結核病的篩檢和預防措施，是避免群聚感染、降低結核菌感染及發病率的重要課題。在全世界苦思如何根治結核病的同時，照護機構內的預防不應只被動的依賴卡介苗的注射及症狀出現後的診斷治療。機構內除了落實行政管理、環境控制及個人防護外，亦應考慮連用連續的結核菌素皮膚測試或採用體外結核菌抗原刺激丙種擾素是生之QFT-G檢驗作為監測的方式。

Tuberculolsis (TB) continues to be a leading cause of morbidity and mortality among all infectious diseases in Taiwan. The subtle clinical manifestations of TB and the limited sensitivity and efficiency of detection techniques, often pose a diagnostic and preventive challenge. Staff and residents in long-term care facilities are at a higher risk both for reactivation of latent TB and acquisition of new TB infections. Thus, it is important to establish a rational process of screening, prevention, and control in long-term care facilities. We discuss herein recent guidelines and articles of TB prevention and control, and considering the domestic policy, attempt to formulate coping strategies in long-term care facilities. Such a strategy is based on a three-level hierarchy of controls, including administrative, environmental control, and respiratory protection. In addition to standard sputum studies and chest radiographs, serial tuberculin skin tests, or QFT-G, may be a rational choice of screening and monitoring in long-term care facilities.