Abu-Raddad Laith J, Sabatelli Lorenzo, Achterberg Jerusha T, Sugimoto Jonathan D, Longini Ira M, Dye Christopher, Halloran M Elizabeth
Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
Proc Natl Acad Sci U S A. 2009 Aug 18;106(33):13980-5. doi: 10.1073/pnas.0901720106. Epub 2009 Aug 3.
The Bill and Melinda Gates Foundation supports an ambitious portfolio of novel vaccines, drug regimens, and diagnostic tools for tuberculosis (TB). We elicited the expected efficacies and improvements of the novel interventions in discussions with the foundations managing their development. Using an age-structured mathematical model of TB, we explored the potential benefits of novel interventions under development and those not yet in the portfolio, focusing on the WHO Southeast Asia region. Neonatal vaccination with the portfolio vaccine decreases TB incidence by 39% to 52% by 2050. Drug regimens that shorten treatment duration and are efficacious against drug-resistant strains reduce incidence by 10-27%. New diagnostics reduce incidence by 13-42%. A triple combination of a portfolio vaccine, drug regimen, and diagnostics reduces incidence by 71%. A short mass vaccination catch-up campaign, not yet in the portfolio, to augment the triple combination, accelerates the decrease, preventing >30% more cases by 2050 than just the triple combination. New vaccines and drug regimens targeted at the vast reservoir of latently infected people, not in the portfolio, would reduce incidence by 37% and 82%, respectively. The combination of preventive latent therapy and a 2-month drug treatment regimen reduces incidence by 94%. Novel technologies in the pipeline would achieve substantial reductions in TB incidence, but not the Stop TB Partnership target for elimination. Elimination will require new delivery strategies, such as mass vaccination campaigns, and new products targeted at latently infected people.
比尔及梅琳达·盖茨基金会支持一系列针对结核病的雄心勃勃的新型疫苗、药物疗法和诊断工具项目。我们在与负责其研发的基金会的讨论中，得出了这些新型干预措施预期的疗效和改进情况。利用结核病的年龄结构数学模型，我们探讨了正在研发的新型干预措施以及尚未纳入项目的措施的潜在益处，重点关注世界卫生组织东南亚区域。到2050年，使用项目疫苗进行新生儿疫苗接种可使结核病发病率降低39%至52%。缩短治疗时间且对耐药菌株有效的药物疗法可使发病率降低10%至27%。新型诊断方法可使发病率降低13%至42%。项目疫苗、药物疗法和诊断方法的三联组合可使发病率降低71%。尚未纳入项目的短期大规模疫苗接种补种活动，作为对三联组合的补充，可加速发病率的下降，到2050年比仅采用三联组合多预防30%以上的病例。针对大量潜伏感染人群（尚未纳入项目）的新型疫苗和药物疗法分别可使发病率降低37%和82%。预防性潜伏治疗与为期2个月的药物治疗方案相结合可使发病率降低94%。正在研发的新技术将大幅降低结核病发病率，但无法实现终止结核病伙伴关系的消除目标。消除结核病将需要新的推广策略，如大规模疫苗接种活动，以及针对潜伏感染人群的新产品。
