陳秀熙張淑惠臺灣大學：葉彥伯Yeh, Yen-PoYen-PoYeh2007-11-272018-06-292007-11-272018-06-292005http://ntur.lib.ntu.edu.tw//handle/246246/56203The resurgence of tuberculosis (TB) in Taiwan began since 1991, with a later tremendous soar-up after 1996. The epidemiological characteristics of TB in Taiwan have two points and one emerging issue. The first is the high coverage, i.e. more than 90%, of BCG vaccination in the general population. The second is the persistent high (around three to four times that of general population) TB incidence in the aboriginal mountain townships. The interference of BCG vaccination with tuberculin skin test (TST) is important and should determine the feasibility of TST as a tool for detecting TB infection in Taiwan, when TST was increasingly used for contact investigation and treatment of latent TB infection (LTBI) during the past decade. The unusual high TB incidence in aboriginal mountain areas raises the question: whether the resurgence of TB in Taiwan could be attributed to the preponderance of TB cases in the aboriginal? What’s the major pattern of transmission links between mountain areas and their surroundings? Answers to these questions have profound implications for developing TB control strategies in Taiwan. The emerging issue pertains to the increasing number of foreign laborers from countries with high-prevalence of TB. During past decade, more than 350,000 immigrants have entered this country as workers, housewives and babysitters. The potential impact of immigrant TB needs further evaluation.致謝 vii Abstract viii Specific Aims xiii Chapter 1 Introduction 1 Chapter 2 Literature Review 12 I. General Review of Tuberculosis　 12 1. Global Burden of Tuberculosis　12 2. Disease Natural History of Tuberculosis　13 3. Transmission of Tuberculosis　15 4. Recent Findings of Molecular Epidemiology and the Re-definition of Contacts 　16 5. Infective Sources of Tuberculosis 　19 6. Risk of Developing Tuberculosis Following Infection　21 7. Models for the Disease Natural History of Tuberculosis　22 8. Control Strategy of Tuberculosis　23 9. Tuberculin Skin Test　24 10. BCG Vaccination and TST　25 11. Treatment of Latent Tuberculosis Infection　27 12. Revisit to TB Control Strategies　32 13. TB Control Strategies: US Experience　33 II. Tuberculosis in Taiwan　36 1. Mortality　36 2. Morbidity　37 3. Human Immunodeficiency Virus and Tuberculosis　38 4. Anti-tuberculosis Drug Resistance　39 III. Interpretation of Incidence of Tuberculosis in Mountain Areas and Surrounding Townships: Dose-response Relationship by Geographic Analysis　　40 IV. Brief Summary　46 Chapter 3 Materials and Methods　50 Part I　Tuberculin Reactivity in Adults after 50 Years of Universal Bacille Calmette-Guerin Vaccination 1. Study Subjects 2. BCG Vaccination and Cut-off Point for Positive TSTs 3. Historical Data on Annual Risk of Tuberculosis Infection 4. Statistical Analysis　　　50 Part II　Molecular Epidemiology of Tuberculosis in Mountain Areas and Surrounding Townships in Middle Taiwan 1. Study Population 2. Setting 3. Mycobacterium tuberculosis Isolates and RFLP Analysis 4. Epidemiological Investigation　　　54 Part III　　Estimating Reproductive Number of Tuberculosis in Selected Population 1. Target Population and Data Source 2. Mathematical Model for Estimating Reproductive Number 3. Procedure of Assessment 4. Model Specification　　　　　　　　　　　59 Part IV　A Cost-effective Analysis of Tuberculosis Control Strategies in Taiwan IV-1. A Stochastic Model for the Disease Natural History of Tuberculosis 1. Model Specification 2. Model Description IV-2. Procedure Assessment　　　　61 Chapter 4 Results　　65 Part I　　65 Part II　　67 Part III　　69 Part IV　　70 Chapter 5 Discussion　　73 Part I 　　73 Part II　　77 Part III　　79 Part IV　　80 Chapter 6　　Conclusion　　82 Reference　　83 Tables　　99 Figure Legends　　116 Figures　　118 Articles in press or submitting　　1272032403 bytesapplication/pdfen-US台灣結核病AdultTuberculin testBCG vaccineTuberculosis[SDGs]SDG3thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/56203/1/ntu-94-F85821204-1.pdf