Carvalho Anna C C, Migliori Giovanni B, Cirillo Daniela M
Institute of Infectious and Tropical Diseases, Università degli Studi di Brescia, Piazzale Spedali Civili 1, 25125 Brescia, Italy.
Expert Rev Respir Med. 2010 Apr;4(2):189-200. doi: 10.1586/ers.10.7.
Tuberculosis has re-emerged as a public health concern in high-income countries in the last few decades. The European region accounts for only 5% of world TB cases. The incidence of new TB cases in Europe varies from very low rates in Scandinavian countries (six to eight cases/100,000 population) to rates as high as 231 cases/100,000 population in Tajikistan; the Russian Federation is eleventh among the 22 high-burden TB countries. The estimated detection rate of new sputum smear-positive pulmonary cases and the treatment success rate in 2007 were poor compared with other WHO regions: 51% of cases were diagnosed and 70% of them completed a full course of anti-TB therapy, which is still a long way from the World Health Assembly targets (detection of 70% of infectious cases and successful treatment of 85% of them). The low success rate is largely attributable to the increasing number of drug-resistant TB cases: Eastern European countries are among those with the highest rates of multidrug-resistant (MDR)-TB (TB resistant to rifampicin and isoniazid) in the world. By the end of September 2009, at least one case of extensively drug-resistant TB (named XDR-TB and defined as a MDR-TB strain with additional resistance to any fluoroquinolone, and to at least one of three injectable drugs used in anti-TB treatment) had been reported by 25 countries in the WHO European Region. In Western Europe, TB continues to cause disease among elderly native-born individuals, although high-risk groups including immigrants, prisoners, HIV-infected persons and drug addicts significantly contribute to the overall burden. Improved TB control in Europe requires a large coordinated effort by all stakeholders, including governments, governmental and non-governmental institutions, as well as the academic and private sectors and affected communities.
在过去几十年里，结核病在高收入国家再度成为一个公共卫生问题。欧洲区域仅占全球结核病病例的5%。欧洲新结核病病例的发病率差异很大，斯堪的纳维亚国家发病率极低（每10万人口中有6至8例），而塔吉克斯坦高达每10万人口中有231例；俄罗斯联邦在22个结核病高负担国家中排第11位。与世界卫生组织其他区域相比，2007年新痰涂片阳性肺结核病例的估计检出率和治疗成功率较低：51%的病例得到诊断，其中70%完成了全程抗结核治疗，这距离世界卫生大会的目标（70%的传染性病例得到检出，其中85%得到成功治疗）仍有很大差距。成功率低很大程度上归因于耐多药结核病病例数量不断增加：东欧国家是世界上耐多药结核病（对利福平及异烟肼耐药的结核病）发病率最高的国家之一。截至2009年9月底，世界卫生组织欧洲区域已有25个国家报告了至少1例广泛耐药结核病（称为XDR-TB，定义为对任何氟喹诺酮类药物以及抗结核治疗中使用的三种注射药物中的至少一种具有额外耐药性的耐多药结核菌株）。在西欧，结核病继续在本地出生的老年人中引发疾病，不过包括移民、囚犯、艾滋病毒感染者和吸毒者在内的高危人群对总体负担也有显著影响。欧洲要改善结核病防控工作，需要政府、政府机构和非政府机构以及学术和私营部门及受影响社区等所有利益攸关方做出大规模的协调努力。
