Background Respiratory isolation of people with pulmonary tuberculosis (TB), including after treatment initiation, is used to prevent community-based transmission; yet guidelines on duration are limited and implementation is heterogeneous. This systematic review synthesized evidence on respiratory isolation for TB to inform National TB Coalition of America guidelines. Methods After searching six databases, eight reviewers screened and extracted data in duplicate on effects of respiratory isolation compared to no isolation or masking. Studies were stratified by outcomes: TB infection or disease in contacts, mortality, hospitalization duration, patient and health system costs, and impact on mental health or stigma. We used a convergent integrated approach to synthesize quantitative and qualitative findings and assess limitations. Results Seventeen studies were included. There were limited data directly comparing isolation to non-isolation interventions, including effects after treatment initiation. One randomized controlled trial suggested treatment in a sanatorium versus at home did not affect TB incidence in contacts. Modelling studies suggest isolation may reduce transmission, but relied on various assumptions, and isolation was implemented alongside other interventions. Descriptive, mixed-methods, and qualitative studies described adverse impacts of isolation on employment, education, food/housing security, and mental health due to transmission fears, stigma and social isolation. Impacts were compounded in marginalized groups including indigenous and incarcerated persons. Conclusion Data to support current isolation practices, particularly after effective treatment initiation, to reduce TB transmission in communities are limited. Public health guidance should weigh the negative impacts on people with TB against decreased community transmission to make evidence-based decisions about respiratory isolation.

中文翻译：

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呼吸隔离对结核病减少社区传播的影响：系统评价


背景 肺结核 （TB） 患者的呼吸隔离，包括治疗开始后，用于防止社区传播;然而，关于持续时间的指导方针是有限的，实施是异质的。本系统评价综合了 TB 呼吸分离的证据，为美国国家结核病联盟指南提供信息。方法 在检索了 6 个数据库后，8 名评价员筛选并提取了与无隔离或掩蔽相比呼吸隔离影响的资料，一式两份。研究按结局分层：接触者中的结核病感染或疾病、死亡率、住院时间、患者和卫生系统成本以及对心理健康或耻辱感的影响。我们使用收敛综合方法来综合定量和定性研究结果并评估局限性。结果 共纳入 17 项研究。直接比较隔离与非隔离干预的数据有限，包括治疗开始后的效果。一项随机对照试验表明，与在家中相比，疗养院治疗不会影响接触者的结核病发病率。建模研究表明，隔离可能会减少传播，但依赖于各种假设，并且隔离与其他干预措施一起实施。描述性、混合方法和定性研究描述了由于传播恐惧、耻辱感和社会孤立，隔离对就业、教育、食品/住房安全和心理健康的不利影响。对包括土著和被监禁者在内的边缘化群体的影响更加复杂。结论支持当前隔离做法的数据有限，尤其是在有效治疗开始后，以减少社区中结核病的传播。 公共卫生指南应权衡对结核病患者的负面影响与减少社区传播，以做出有关呼吸隔离的循证决策。