Centre for Infectious Disease Epidemiology, Department of Infection and Population Health, University College London, London, UK.
Lancet Infect Dis. 2013 Jun;13(6):529-39. doi: 10.1016/S1473-3099(13)70030-6. Epub 2013 Mar 24.
Two decades ago, WHO declared tuberculosis a global emergency, and invested in the highly cost-effective directly observed treatment short-course programme to control the epidemic. At that time, most strains of Mycobacterium tuberculosis were susceptible to first-line tuberculosis drugs, and drug resistance was not a major issue. However, in 2013, tuberculosis remains a major public health concern worldwide, with prevalence of multidrug-resistant (MDR) tuberculosis rising. WHO estimates roughly 630 000 cases of MDR tuberculosis worldwide, with great variation in the frequency of MDR tuberculosis between countries. In the past 8 years, extensively drug-resistant (XDR) tuberculosis has emerged, and has been reported in 84 countries, heralding the possibility of virtually untreatable tuberculosis. Increased population movement, the continuing HIV pandemic, and the rise in MDR tuberculosis pose formidable challenges to the global control of tuberculosis. We provide an overview of the global burden of drug-resistant disease; discuss the social, health service, management, and control issues that fuel and sustain the epidemic; and suggest specific recommendations for important next steps. Visionary political leadership is needed to curb the rise of MDR and XDR tuberculosis worldwide, through sustained funding and the implementation of global and regional action plans.
二十年前，世界卫生组织（WHO）宣布结核病为全球紧急情况，并投资于高成本效益的直接观察治疗短期方案来控制疫情。当时，大多数结核分枝杆菌菌株对一线抗结核药物敏感，耐药性不是主要问题。然而，2013 年，结核病仍然是全球主要的公共卫生关注点，耐多药结核病（MDR-TB）的流行率上升。据世界卫生组织估计，全球约有 63 万例 MDR-TB，各国 MDR-TB 的频率差异很大。在过去的 8 年中，广泛耐药结核病（XDR-TB）已经出现，并在 84 个国家报告，预示着几乎无法治疗的结核病的可能性。人口流动增加、持续的艾滋病毒大流行以及 MDR-TB 的增加，给全球结核病控制带来了严峻挑战。我们提供了全球耐药性疾病负担的概述；讨论了助长和维持这一流行的社会、卫生服务、管理和控制问题；并提出了重要的下一步的具体建议。需要有远见的政治领导来遏制全球耐多药和广泛耐药结核病的上升，通过持续的资金投入和实施全球和区域行动计划。
