BCG接種の利益とBCG接種により結核感染の判断が困難になる不利益の比較分析 COMPARISON OF EFFECTIVENESS OF BCG VACCINATION AND PRESENTIVE THERAPY IN JAPANESE SETTINGS, WITH SPECIAL EMPHASIS ON THE SENSITIVITY AND SPECIFICITY OF TUBERCULIN TESTING

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著者

    • 吉山 崇 YOSHIYAMA Takashi
    • 結核予防会結核研究所 Epidemiology Division, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association

抄録

背景: 結核低蔓延国におけるBCGの意義は議論の的であるが, これまで主に, BCGの効果と, 副作用および費用を論じており, BCGによるツベルクリン反応検査の感度特異度が落ちるためのデメリットが議論されていない。<BR>方法: 現状のBCG接種と接触者検診の状況において, 現状であるBCG接種群とBCG接種を廃止した非接種群に分け, 結核発病者数, 結核関連死亡数, 副作用も含めた結核関連のDALYの損失, 費用を比較した。対象人口は年間感染危険率0.1%の年に生まれた仮想コホートである。<BR>結果と議論: 現状を反映すると思われる接触者検診の状況下では, 接種群が, 結核発病, 死亡, DALYの損失いずれも非接種群より有利であり, 二次感染を考慮しても同様であった。一方, 直接費用は, 非接種群が低かった。接種群では, 接触者検診を広範囲に行うとDALYの損失が大きくなったが, 非接種群では接触者検診はより広範囲に行うほどDALYの損失は減少した。さらに二次感染を考えると, 現在より広範囲に接触者検診を行えば非接種群は接種群よりも有利となった。ただし, 接触者検診の拡大が現実的に可能か否か検討は必要である。

Background: BCG vaccination in low prevalence countries is controversial. Most discussions have been done by the comparison of benefit, side effect and cost of BCG vaccination. No discussion has been done on the disadvantage of BCG vaccination from the point of view of loss of sensitivity and specificity of tuberculin test on the diagnosis of LTBI.<BR>Method: Three groups, i.e. the BCG vaccination group with preventive therapy under worsened sensitivity and specificity of tuberculin test due to previous BCG, no intervention group and non BCG vaccination group with preventive therapy under standard sensitivity and specificity of tuberculin test were set up. The target population was a cohort of Japanese who are born at the year with 0.1% annual risk of tuberculous infection. The TB incidence, TB related mortality (including death by BCG and preventive therapy), TB related loss of DALY (disability adjusted life years), and direct medical cost of the above three groups, for the cohort only and the cohort including secondary TB cases from the clinical cases in the cohort.<BR>Results: Under the current program conditions, the merit of BCG vaccination is greater than the merit obtained from the preventive therapy without BCG. Although the medical direct cost is lowest among the preventive therapy group without BCG, next without BCG or preventive therapy and highest among BCG group. Under BCG group, too extensive screening for LTBI does not reduce the loss of TB related DALY, whereas in the non BCG group, extensive screening will help to reduce the loss of TB related DALY and if more extensive screening can be done, the loss of TB related DALY in the non BCG group can be less than that in the BCG group.<BR>Conclusion: At present extensiveness of screening for LTBI and BCG vaccination contribute to the reduction of TB and loss of TB related DALY. Possible extensive screening without BCG may be able to reduce loss of TB related DALY in comparison to the BCG vaccination group.

収録刊行物

  • 結核

    結核 77(1), 11-22, 2002-01-15

    JAPANESE SOCIETY FOR TUBERCULOSIS

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各種コード

  • NII論文ID(NAID)
    10008113210
  • NII書誌ID(NCID)
    AN00073442
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    00229776
  • NDL 記事登録ID
    026778659
  • NDL 請求記号
    Z19-133
  • データ提供元
    CJP書誌  CJP引用  NDL  J-STAGE 
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