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Gesundheitswesen 2023; 85(11): 1076-1098
DOI: 10.1055/a-2148-7769
Empfehlungen

Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose – Update 2023

Recommendations for Contact Tracing for Tuberculosis – Update 2023
Roland Diel   *
1   Universitätsklinikum Schleswig-Holstein, Campus Kiel
2   Deutsches Zentrum für Lungenforschung, Airway Research Center North (ARCN), LungenClinic Grosshansdorf, Großhansdorf
7   Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
,
Cornelia Breuer
3   Amt für Gesundheit und Prävention der Landeshauptstadt Dresden
7   Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
,
Lena Bös
4   Robert Koch-Institut, Berlin
,
Hilte Geerdes-Fenge
5   Universitätsmedizin Rostock
,
Annette Günther
6   Helios-Klinikum Emil von Behring, Berlin
,
Brit Häcker
7   Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
,
Jörg Hannemann
8   Gesundheitsamt Hamburg-Mitte, Hamburg
,
Albert Nienhaus
9   Berufsgenossenschaft für Gesundheits- und Wohlfahrtspflege, Hamburg
10   Universitätskrankenhaus Eppendorf, Hamburg
,
Martin Priwitzer
11   Gesundheitsamt, Landeshauptstadt Stuttgart
,
Peter Witte
7   Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
12   Institut für Krankenhaushygiene, Universitätsklinikum JWK, Minden
,
Torsten Bauer
6   Helios-Klinikum Emil von Behring, Berlin
7   Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose, Berlin
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Zusammenfassung

Ziel der Umgebungsuntersuchung bei Tuberkulose ist neben der aktiven Fallfindung das Aufdecken von Infektionsketten sowie die Verhütung der Weiterverbreitung der Erkrankung. Dabei ist eine sorgfältige Auswahl der Kontaktpersonen notwendig, die sich nach Art und Dauer des Kontaktes richtet, um möglichst frisch Infizierte zu identifizieren und so den Nutzen einer anschließenden präventiven Therapie zu erhöhen und unnötige Testungen von Personen ohne Ansteckungsrisiko zu vermeiden. Seit der letzten Überarbeitung der Empfehlungen zur Umgebungsuntersuchung hat sich die Datenlage zum Einsatz von Interferon-y release-Assays (IGRAs) bei Kindern weiterhin verbessert. Diese werden bevorzugt in der Umgebungsuntersuchung von erwachsenen Kontaktpersonen eingesetzt. Für Kinder unter 15 Jahren können sowohl IGRAs wie auch weiterhin der Tuberkulin-Hauttest gleichwertig verwendet werden. Als präventive Therapie bei nachgewiesener Infektion werden Rifampicin für 4 Monate, Rifampicin und Isoniazid für 3 Monate oder aber Isoniazid für 9 Monate empfohlen.

Ausführlich wird auf die Durchführung der Umgebungsuntersuchung in verschiedenen Altersgruppen sowie rechtliche Rahmenbedingungen und sozialmedizinische Aspekte und Herausforderungen eingegangen. Zusätzlich werden Sonderfälle, wie die Umgebungsuntersuchung in Kitas, Schulen oder in anderen Gemeinschaftseinrichtungen, separat dargestellt.

Abstract

The aim of contact tracing for tuberculosis is in addition to active case finding the detection of chains of infection and the prevention of the further spread of the disease. In this context, a careful selection of contact persons is necessary, depending on the type and duration of contact, to identify persons who are recently infected and therefore to increase the benefit of a preventive therapy and to avoid unnecessary testing of persons who are not at risk of infection. Since the last update of the recommendations on contact tracing, data on the use of interferon-y release assays (IGRAs) in children has been improved markedly. These are the preferred test in contact tracing of adults. For children, both IGRAs and the tuberculin skin test can be used equivalently. Rifampicin for 4 months, rifampicin and isoniazid for 3 months, or isoniazid for 9 months are recommended as preventive therapy in cases of confirmed infection.

The implementation of the contact tracing in different age groups as well as legal framework conditions and socio-medical aspects and challenges are dealt with in detail. In addition, special cases, such as environmental screening in day-care centers, schools, or other community facilities, are discussed separately.

Schlüsselwörter

Tuberkulose - Umgebungsuntersuchung - TB-Kontakt - Kontaktnachverfolgung - LTBI

Key words

Tuberculosis - contact tracing - contact investigation - latent tb infection - LTBI - TB contact

1 Als Indexperson wird die an Tuberkulose erkrankte Person bezeichnet, die die Umgebungsuntersuchungen ausgelöst hat.


* federführend




Publication History

Article published online:
16 November 2023

© 2023. Thieme. All rights reserved.

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