Nunn Paul, Zignol Matteo, Jaramillo Ernesto, Wright Abigail, Getahun Haileyesus
World Health Organization, Stop TB Department, Avenue Appia 1211 Geneva, Switzerland.
Ethiop Med J. 2007 Oct;45(4):399-404.
In most of the world and particularly in Eastern Europe, China and India, drug resistance is increasingly seen as a major threat to tuberculosis (TB) control and even to public health and health security. What about in Africa? The conditions for creation of drug resistance exist in most, if not all, African countries, as a result of underinvestment in basic TB control, poor management of anti-TB drugs and virtual absence of infection control measures. The severity of drug resistance is increasing--following outbreaks all over the world of multi-drug resistant TB (MDR) in the 1990's, extensive drug resistant (XDR) TB has now been found in 37 countries, including South Africa. (MDR is, in essence, resistance to the most powerful first-line drugs, and XDR-TB is TB resistant to the most powerful second-line drugs as well.) Worse still, the impact of XDR-TB is magnified among those with HIV infection, giving rise to a remarkably high mortality, and exposing significant weaknesses in both HIV and TB control. In particular, the lack of laboratories capable of carrying out culture and drug susceptibility testing severely limits the capacity of countries even to detect the problem in Africa. This paper analyses the threat of TB drug resistance to health and to TB control in Africa, and puts forward measures to diminish this threat.
在世界上大多数地区，尤其是东欧、中国和印度，耐药性日益被视为结核病防控乃至公共卫生与卫生安全的重大威胁。非洲的情况如何呢？由于对基本结核病防控投入不足、抗结核药物管理不善以及几乎没有感染控制措施，在多数（即便不是所有）非洲国家都存在产生耐药性的条件。耐药性的严重程度正在加剧——继20世纪90年代全球多地爆发耐多药结核病（MDR）之后，目前在包括南非在内的37个国家发现了广泛耐药结核病（XDR）。（本质上，耐多药是指对最有效的一线药物产生耐药，而广泛耐药结核病是指对最有效的二线药物也产生耐药。）更糟糕的是，广泛耐药结核病在艾滋病毒感染者中的影响被放大，导致极高的死亡率，并暴露出艾滋病毒和结核病防控方面的重大弱点。特别是，缺乏能够开展培养和药敏试验的实验室严重限制了非洲各国发现这一问题的能力。本文分析了结核病耐药性对非洲健康和结核病防控的威胁，并提出了减少这一威胁的措施。
