Lönnroth Knut, Raviglione Mario
Stop TB Department, World Health Organization, Geneva, Switzerland.
Semin Respir Crit Care Med. 2008 Oct;29(5):481-91. doi: 10.1055/s-0028-1085700. Epub 2008 Sep 22.
The burden of tuberculosis (TB) is now very slowly decreasing globally. However, the rate of decline is too slow to reach all the epidemiological impact targets set for 2015. The prospects for reaching the TB elimination target set for 2050 are even bleaker. Implementation of the World Health Organization's Stop TB Strategy is currently lagging behind the envisioned scale-up pace, particularly with regard to TB/HIV collaborative activities and management of drug resistant TB. To ensure long-term TB control there is, first, a need to ensure that all components of the Stop TB Strategy are scaled up according to plans, with special attention to improved access for the poor. However, this may not be enough. Recent analyses suggest that the impact of current efforts to reduce TB incidence is less than expected and that improved diagnostic and curative efforts need to be combined with additional preventive efforts. New and more effective vaccines and drugs for preventive treatment would revolutionize TB control. A stronger focus on prevention would also entail more concerted actions to limit the impact of TB risk factors, including HIV/AIDS, smoking, malnutrition, alcoholism, diabetes, crowded living conditions, and indoor air pollution, which may all contribute a considerable proportion of the global TB burden.
目前，全球结核病负担正以非常缓慢的速度下降。然而，下降速度过慢，无法实现为2015年设定的所有流行病学影响目标。实现为2050年设定的结核病消除目标的前景更加黯淡。世界卫生组织《终止结核病战略》的实施目前落后于预期的扩大规模速度，特别是在结核病/艾滋病协作活动和耐多药结核病管理方面。为确保结核病的长期控制，首先需要确保《终止结核病战略》的所有组成部分按计划扩大规模，特别要关注改善贫困人口的可及性。然而，这可能还不够。最近的分析表明，当前降低结核病发病率努力的影响低于预期，需要将改进的诊断和治疗努力与额外的预防努力相结合。新型、更有效的预防性治疗疫苗和药物将彻底改变结核病控制局面。更加强调预防还需要采取更协调一致的行动，以限制结核病风险因素的影响，包括艾滋病毒/艾滋病、吸烟、营养不良、酗酒、糖尿病、居住环境拥挤和室内空气污染，这些因素可能都在全球结核病负担中占相当大的比例。
