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1

2 FAX FAX

3 QFT QFT QFT QFT QFT QFT-3G QFT QFT window period QFT QFT X

4 IGRA QFT-3G IGRA QFT T-SPOT QFT-3G T-SPOT IGRA IGRA IGRA IGRA BCG IGRA IGRA IGRA IGRA 遡 social network analysissna

5

6

7 elimination 21 DOTS 2005 CDCCenters for Disease Control and Prevention NTCANational Tuberculosis Controllers Association 1998 CDHSCTCA Joint Guidelines EBM Evidence-Based Medicine 1

8 IGRA IGRA IGRA latent tuberculosis infectionltbi

9 contact investigation medical examination LTBI

10 23 LTBI 15 4

11 TBCTA Tuberculosis Coalition for Technical Assistance) 5

12 X 6

13 穿 穿 穿 7

14 ) 15 8

15 index case contact high-risk contact BCG HIV TNF- close contact CDCNTCA WHO

16 () (N95 )( ) ) casual contact non-contact 10

17 period of infectiousness 遡 CDC 3 CDC WHO 12 遡 3 遡 78 13) 遡 3 遡 11

18 遡 遡 78 13) 遡 遡 (1+)1 (3+) 遡 12

19 IGRA BCG BCG Interferon-gamma release assayigra 18 1 (R) TB-2GQFT-2G QFT QuantiFERON TB Gold In-TubeQFT-3G 21 (R) TB QFT-3G QFT-2G QFT-2G QFT-3G T- (R) TB T-SPOT IGRA QFT-3G T-SPOT IGRA QFT T-SPOT QFT-2G IGRA QFT-3G T-SPOT IGRA (1) QFT-3G T-SPOT QFT-3G T-SPOT T-SPOT QFT-3G 14-16) 17) IGRA 18) LTBI LTBI gold standard T-SPOT LTBI IGRA QFT-3G T-SPOT 13

20 QFT-3G QFT-3G T-SPOT ,6,7 IGRA - 19) (2) IGRA IGRA IGRA QFT-3G 17 QFT-2G IGRA IGRA IGRA IGRA 50 IGRA LTBI IGRA IGRAQFT-2G IGRA 20 IGRA IGRAQFT-3G 21 IGRA 60 IGRA 60 IGRA 14

21 21 22 IGRA IGRA IGRA IGRA IGRA IGRA LTBI IGRA IGRA QFT-2G QFT-3G QFT-2G T-SPOT 18 LTBI QFT-3G 18 BCG IGRA IGRA IGRA LTBI IGRA systematic review IGRA 5 23) LTBI IGRA IGRA BCG IGRA IGRA 3 IGRA IGRA BCG BCG 10mm 15

22 IGRA IGRA (3) IGRA IGRA QFT IGRA : window period QFT 2526 IGRA IGRA IGRA IGRA IGRA (4) IGRA IGRA IGRA IGRA IGRA IGRA IGRA 47.6 IGRA IGRA 16

23 50 IGRA IGRA 1 IGRA IGRA IGRA (5) IGRA IGRA IGRA QFT-3G 1 2 IGRA - 19 QFT-3G T-SPOT IGRA 17

24 12 6 index case (

25 X N95 19

26

27 , BCG 21

28 22

29 HIV 23

30 ? 24

31 BCG 25

32 BCG LTBI BCG LTBI IGRA 15 26

33 WHO 27

34 10 28

35 LTBI IGRA IGRA 29

36 BCG IGRA IGRA IGRA IGRA BCG IGRA IGRA IGRA IGRA IGRAQFT-3G T-SPOT IGRA IGRA IGRA LTBIIGRA IGRA 30

37 IGRA BCG BCG 10mm IGRA IGRA BCG BCG BCG 10mm IGRA BCG IGRA IGRA BCG 30mm IGRA 11 BCG 30mm IGRA BCG 30mm IGRA 28 BCG IGRA 6 12 IGRA IGRA IGRA IGRA 31

38 IGRA IGRA IGRA IGRA 2526 IGRA 15 IGRA IGRA IGRA 12 1 LTBI IGRA CT IGRA QFT-3G QFT-3G QFT QFT T-SPOT QFT-3G T-SPOT IGRA 32

39 15% IGRA QFT-3G QFT-3G QFT-3G IGRA IGRA IGRA IGRA IGRA IGRA IGRA LTBI IGRA 8090 IGRA HIV IGRA IGRA IGRA IGRA IGRA IGRA X 33

40 --(2) IGRA BCG BCG 10mm IGRA IGRA BCG LTBI IGRA LTBI BCG IGRA 30mm IGRA 34

41 BCG BCG IGRA IGRA IGRA IGRA LTBI 18 LTBI IGRA BCG IGRA 35

42 36 LTBI LTBI LTBI

43 IGRA IGRA IGRA LTBI 37

44 QFT LTBI QFT LTBI LTBI LTBI INH INH IGRA BCG 38

45 INH CT LTBI INH INH 6 9 INH INH RFP 21 DOTS LTBI BCG HIV IGRA LTBI INH IGRA BCG BCG LTBI 6 9 IGRA IGRA INH IGRAIGRA INH BCG IGRAINH 33 LTBI IGRA LTBI BCG LTBI IGRA BCG 39

46 INH 0.2g/ml LTBI RFP 4 6 INH RFP INH RFP PZAEB PZA 612 ATS/CDC mg/ 35 LTBI 36 LTBI ATS/CDC 34 LTBI 15 LTBI

47 LTBI 4 DNA,, 41

48 IGRA

49 IGRA IGRA LTBI 43

50

51 15 14 RFLP Restriction Fragment Length Polymorphism VNTR Variable Numbers of Tandem Repeats DNA fingerprinting analysis 15 45

52 IGRA RFLP VNTR DNA

53 diffuse outbreak

54 IS6110 RFLP RFLP VNTR 48

55 VNTR 2012 VNTR 41 JATA(12)-VNTR 12 VNTR VNTR RFLP Social Network AnalysisSNA SNA 49

56 SNA SNA LTBI 42 RFLP VNTR 19 5 XDR-TB) VNTR VNTR 50

57 JATA(12)-VNTR JATA(12)-VNTR VNTR VNTR JATA(12)-VNTR VNTR VNTR VNTR CDC: Guidelines for the investigation of contacts of persons with infectious tuberculosis; recommendations from the National Tuberculosis Controllers Association and CDC, United States. MMWR 54(RR-15), California Department of Health Services Tuberculosis Control Branch; California Tuberculosis Controllers Association: Contact investigation guidelines. Berkeley, CA: California Department of Health Services; p Tuberculosis Coalition for Technical Assistance: International Standards for Tuberculosis Care (ISTC). The Hague: Tuberculosis Coalition for Technical Assistance, Conde MB, Loivos AC, Rezende VM, et al.: Yield of sputum induction in the diagnosis of pleural tuberculosis. Am J Respir Crit Care Med 167: ; CDC: Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, MMWR 54(No. RR-17): 42, Madhi F, Fuhrman C, Monnet I, et al.: Transmission of tuberculosis from adults to children in a Paris suburb. Pediatr Pulmonol 34: ; CDC: Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, MMWR 54(No. RR-17): 5-6, ,141 51

58 WHO: Tuberculosis and air travel : guidelines for prevention and control. 3rd ed, Geneva, Switzerland: WHO; WHO: Recommendations for Investigating Contacts of Persons with Infectious Tuberculosis in Low- and Middle-Income Countries. WHO, Geneva, Pai M, Zwerling A, Menzie D.: Systematic Review: T-Cell based Assays for the Diagnosis of Latent Tuberculosis Infection: An Update. Ann Intern Med 149: , Diel R, Loddenkemper R and Nienhaus A.: Evidence-based comparison of commercial interferon- release assays for detecting active TB. Chest 137: , Sester M, Sotgiu G, Lange C et al. Interferon- release assays for the diagnosis of active tuberculosis:a systematic review and meta-analysis. Eur Respir J 37: , Higuchi K, Sekiya Y, Igari H et al.: Comparison of specificities between two interferon-gamma release assays in Japan. Int J Tuberc Lung Dis 16: , QFT-GIT T-SPOT TB Mori T, Harada N, Higuchi K, et al.: Waning of the specific interferon-gamma response after years of tuberculosis infection. Int J Tuberc Lung Dis 11:1021-5, : VNTR 88: , Mandalakas AM, Detjen AK, Hesseling AC et al. Interferon-gamma release assays and childhood tuberculosis: systematic review and meta-analysis. Int J Tuberc Lung Dis 15: , Anibarro L et al. Tuberculin skin test and interferon-γ release assay show better correlation after the tuberculin window period' in tuberculosis contacts. Scand J Infect Dis 43: , Lee SW, Oh DK, Lee SH, et al. Time interval to conversion of interferon-γ release assay after exposure to tuberculosis. Eur Respir J 37 : ,

59 26 QFT 61 87: , Abubakar I: Tuberculosis and air travel: a systematic review and analysis of policy, Lancet Infect Dis. 10: , 辻 QFT-2G 80: , : 26-27, : , Chiba Y: Significance of endogenous reactivation, 30 years follow-up of tuberculin positive converters, Bull IUAT 49: , Sutherland I: The ten-year incidence of clinical tuberculosis following conversion in 2,550 individuals aged 14 to 19 years. TSRU Progress Report 1968 (KNCV, The Hague, The Netherlands) 33 6: ATS/CDC: Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 161:S221 S247; Iseman MA: A Clinician's Guide to Tuberculosis. Lippencott Williams & Wilkins, Philadelphia: , The National Collaborating Centre for Chronic Conditions: Tuberculosis, Clinical diagnosis and management of tuberculosis, and measures for its prevention and control. Royal College of Physicians, London, : , : , CDC: Controlling Tuberculosis in the United StatesRecommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR 54 (RR-12), : 45-57, ) VNTR McElroy PD, Rothenberg RB, Varghese R, et al.: A network-informed approach to investigating a tuberculosis outbreak: implications for enhancing contact investigations. Int J Tuberc Lung Dis. 7: ,

60 徘 LTBI 54

61

62 COI COI COI COI IGRA COI %

結核の接触者健康診断の手引き(改訂第4版)

結核の接触者健康診断の手引き(改訂第4版) 2022 22 4 990-0031 FAX 023-641-7486 19 4 2007 4 18 19 7 2007 7 19 6 7 0308001 6 15 20 6 2008 6 1) 20 9 7 0907001 10 1 2) 4 3) QFT 4) QFT QFT 22 6 2010 6 QFT QFT QFT-3G QFT QFT window period QFT QFT X 19

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