Veterans Affairs Medical Center and George Washington University, Washington, DC, USA.
JAMA. 2012 Jul 18;308(3):283-9. doi: 10.1001/jama.2012.7505.
Tuberculosis is a major threat to global health, infecting a third of the world's population. In the United States, however, control of tuberculosis has been increasingly successful. Only 3.2% of the US population is estimated to have latent tuberculosis and there are only 11,000 cases annually of active disease. More than half the cases in this country occur in individuals born outside the United States. Human immunodeficiency virus coinfection is not a major factor in the United States, since only approximately 10% of cases are coinfected. Drug resistance is also uncommon in this country. Because the United States has more resources for the diagnosis, therapy, and public health control of tuberculosis than many regions of the world, and because many hospitals have more cases of clinically significant nontuberculous mycobacteria than tuberculosis, the management approaches to tuberculosis need to be quite different in this country than in other regions. The resurgence in interest in developing new tools and the investment in public health infrastructure will hopefully be sustained in the United States so that the effect of tuberculosis on the US population will continue to diminish, and these new tools and approaches can be adapted to both high and low prevalence areas to meet the global challenge.
结核病是全球健康的主要威胁，全球有三分之一的人口受到感染。然而，在美国，结核病的控制越来越成功。据估计，只有 3.2%的美国人口患有潜伏性结核病，每年只有 1.1 万例活动性疾病。该国超过一半的病例发生在出生于美国境外的人身上。人类免疫缺陷病毒合并感染在美国不是一个主要因素，因为只有大约 10%的病例合并感染。耐药性在该国也不常见。由于美国在结核病的诊断、治疗和公共卫生控制方面拥有比世界许多地区更多的资源，而且许多医院的临床显著非结核分枝杆菌病例比结核病多，因此，该国的结核病管理方法与其他地区有很大不同。美国对开发新工具的兴趣重新高涨，对公共卫生基础设施的投资有望持续下去，希望结核病对美国人口的影响继续减少，这些新工具和方法可以适应高患病率和低患病率地区，以应对全球挑战。
