MMWR Recomm Rep. 1992 Jun 19;41(RR-11):5-48.
At no time in recent history has tuberculosis (TB) been as great a concern as it is today. TB cases are on the increase, and the most serious aspect of the problem is the recent occurrence of outbreaks of multidrug-resistant (MDR) TB, which pose an urgent public health problem and require rapid intervention. A Task Force composed of representatives of many federal agencies has developed a National Action Plan for addressing this problem. The Task Force identified a number of objectives to be met if MDR-TB is to be successfully combatted. These objectives fall under the categories of a) surveillance and epidemiology--determining the magnitude and nature of the problem; b) laboratory diagnosis--improving the rapidity, sensitivity, and reliability of diagnostic methods for MDR-TB; c) patient management--effectively managing patients who have MDR-TB and preventing patients with drug-susceptible TB from developing drug-resistant disease; d) screening and preventive therapy--identifying persons who are infected with or at risk of developing MDR-TB and preventing them from developing clinically active TB; e) infection control--minimizing the risk of transmission of MDR-TB to patients, workers, and others in institutional settings; f) outbreak control; g) program evaluation--ensuring that TB programs are effective in managing patients and preventing MDR-TB; h) information dissemination/training and education; and i) research to provide new, more effective tools with which to combat MDR-TB. The Action Plan lays out a series of activities to be undertaken at the national level. For each category, the Plan presents statements of problems to be overcome, followed by a summary of the objective to be achieved and steps to be carried out. For each implementation step, responsibility is assigned to the appropriate organization and start-up dates are listed.
在近代史上，结核病从未像现在这样令人担忧。结核病病例正在增加，而问题最严重的方面是最近出现的耐多药结核病疫情，这构成了紧迫的公共卫生问题，需要迅速干预。一个由许多联邦机构代表组成的特别工作组制定了一项应对这一问题的国家行动计划。该特别工作组确定了若要成功抗击耐多药结核病需实现的若干目标。这些目标分为以下几类：a) 监测与流行病学——确定问题的严重程度和性质；b) 实验室诊断——提高耐多药结核病诊断方法的快速性、敏感性和可靠性；c) 患者管理——有效管理耐多药结核病患者，并防止药物敏感结核病患者发展为耐药疾病；d) 筛查与预防性治疗——识别感染耐多药结核病或有感染风险的人，并防止他们发展为临床活动性结核病；e) 感染控制——将耐多药结核病在机构环境中传播给患者、工作人员和其他人的风险降至最低；f) 疫情控制；g) 项目评估——确保结核病项目在管理患者和预防耐多药结核病方面有效；h) 信息传播/培训与教育；i) 研究，以提供新的、更有效的抗击耐多药结核病的工具。该行动计划列出了一系列将在国家层面开展的活动。对于每个类别，该计划都提出了需要克服的问题陈述，随后是要实现的目标和要采取的步骤的总结。对于每个实施步骤，都指定了适当的组织负责，并列出了启动日期。
