Broekmans J F, Migliori G B, Rieder H L, Lees J, Ruutu P, Loddenkemper R, Raviglione M C
Royal Netherlands Tuberculosis Association, The Hague, The Netherlands.
Eur Respir J. 2002 Apr;19(4):765-75. doi: 10.1183/09031936.02.00261402.
As countries approach the elimination phase of tuberculosis, specific problems and challenges emerge, due to the steadily declining incidence in the native population, the gradually increasing importance of the importation of latent tuberculosis infection and tuberculosis from other countries and the emergence of groups at particularly high risk of tuberculosis. Therefore, a Working Group of the World Health Organization (WHO), the International Union Against Tuberculosis and Lung Disease (IUATLD) and the Royal Netherlands Tuberculosis Association (KNCV) have developed a new framework for low incidence countries based on concepts and definitions consistent with those of previous recommendations from WHO/IUATLD Working Groups. In low-incidence countries, a broader spectrum of interventions is available and feasible, including: 1) a general approach to tuberculosis which ensures rapid detection and treatment of all the cases and prevention of unnecessary deaths; 2) an overall control strategy aimed at reducing the incidence of tuberculosis infection (risk-group management and prevention of transmission of infection in institutional settings) and 3) a tuberculosis elimination strategy aimed at reducing the prevalence of tuberculosis infection (outbreak management and provision of preventive therapy for specified groups and individuals). Government and private sector commitment towards elimination, effective case detection among symptomatic individuals together with active case finding in special groups, standard treatment of disease and infection, access to tuberculosis diagnostic and treatment services, prevention (e.g. through screening and bacille Calmette-Guéria immunization in specified groups), surveillance and treatment outcome monitoring are prerequisites to implementing the policy package recommended in this new framework document.
随着各国接近结核病消除阶段，由于本国人口发病率稳步下降、潜伏性结核感染和结核病从其他国家输入的重要性逐渐增加以及结核病高危群体的出现，特定问题和挑战随之浮现。因此，世界卫生组织（WHO）、国际防痨和肺部疾病联盟（IUATLD）以及荷兰皇家结核病协会（KNCV）的一个工作组，基于与WHO/IUATLD工作组先前建议一致的概念和定义，为低发病率国家制定了一个新框架。在低发病率国家，可以采用更广泛的一系列可行干预措施，包括：1）一种结核病总体应对方法，确保对所有病例进行快速检测和治疗，并预防不必要的死亡；2）一项旨在降低结核感染发病率的总体控制策略（风险群体管理以及在机构环境中预防感染传播），以及3）一项旨在降低结核感染患病率的结核病消除策略（疫情管理以及为特定群体和个人提供预防性治疗）。政府和私营部门对消除结核病的承诺、对有症状个体的有效病例检测以及在特殊群体中的主动病例发现、疾病和感染的标准化治疗、获得结核病诊断和治疗服务、预防措施（例如通过在特定群体中进行筛查和卡介苗免疫接种）、监测以及治疗结果监测，是实施这份新框架文件中所建议的一揽子政策的先决条件。
