儿童耐多药结核病发病情况：系统评价和全球估计。
Incidence of multidrug-resistant tuberculosis disease in children: systematic review and global estimates.
机构信息
Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
出版信息
Lancet. 2014 May 3;383(9928):1572-9. doi: 10.1016/S0140-6736(14)60195-1. Epub 2014 Mar 24.
BACKGROUND
Multidrug-resistant tuberculosis threatens to reverse recent reductions in global tuberculosis incidence. Although children younger than 15 years constitute more than 25% of the worldwide population, the global incidence of multidrug-resistant tuberculosis disease in children has never been quantified. We aimed to estimate the regional and global annual incidence of multidrug-resistant tuberculosis in children.
METHODS
We developed two models: one to estimate the setting-specific risk of multidrug-resistant tuberculosis among child cases of tuberculosis, and a second to estimate the setting-specific incidence of tuberculosis disease in children. The model for risk of multidrug-resistant tuberculosis among children with tuberculosis needed a systematic literature review. We multiplied the setting-specific estimates of multidrug-resistant tuberculosis risk and tuberculosis incidence to estimate regional and global incidence of multidrug-resistant tuberculosis disease in children in 2010.
FINDINGS
We identified 3403 papers, of which 97 studies met inclusion criteria for the systematic review of risk of multidrug-resistant tuberculosis. 31 studies reported the risk of multidrug-resistant tuberculosis in both children and treatment-naive adults with tuberculosis and were used for evaluation of the linear association between multidrug-resistant disease risk in these two patient groups. We identified that the setting-specific risk of multidrug-resistant tuberculosis was nearly identical in children and treatment-naive adults with tuberculosis, consistent with the assertion that multidrug-resistant disease in both groups reflects the local risk of transmitted multidrug-resistant tuberculosis. After application of these calculated risks, we estimated that around 999,792 (95% CI 937,877-1,055,414) children developed tuberculosis disease in 2010, of whom 31,948 (25,594-38,663) had multidrug-resistant disease.
INTERPRETATION
Our estimates underscore that many cases of tuberculosis and multidrug-resistant tuberculosis disease are not being detected in children. Future estimates can be refined as more and better tuberculosis data and new diagnostic instruments become available.
FUNDING
US National Institutes of Health, the Helmut Wolfgang Schumann Fellowship in Preventive Medicine at Harvard Medical School, the Norman E Zinberg Fellowship at Harvard Medical School, and the Doris and Howard Hiatt Residency in Global Health Equity and Internal Medicine at the Brigham and Women's Hospital.
背景
耐多药结核病有可能使全球结核病发病率的近期下降趋势出现逆转。尽管 15 岁以下儿童占全球人口的 25%以上，但全球儿童耐多药结核病的发病情况从未得到量化。我们旨在估计全球范围内儿童耐多药结核病的地区和全球年发病率。
方法
我们开发了两种模型：一种用于估计儿童结核病病例中耐多药结核病的特定环境风险，另一种用于估计儿童结核病的特定环境发病情况。儿童结核病耐多药风险模型需要进行系统的文献综述。我们将特定环境下耐多药结核病风险和结核病发病率的估计相乘，以估计 2010 年全球范围内儿童耐多药结核病的发病率。
结果
我们确定了 3403 篇论文，其中 97 项研究符合耐多药结核病风险系统综述的纳入标准。31 项研究报告了儿童和未经治疗的初治成人结核病患者中耐多药结核病的风险，这些研究被用于评估这两组患者群体中耐多药疾病风险之间的线性关联。我们发现，儿童和未经治疗的初治成人结核病患者中耐多药结核病的特定环境风险几乎相同，这与两组人群中的耐多药疾病均反映了当地传播的耐多药结核病风险的说法一致。在应用这些计算出的风险后，我们估计 2010 年约有 999792 名（95%CI937877-1055414）儿童发生结核病，其中 31948 名（25594-38663）患有耐多药疾病。
解释
我们的估计突显了许多儿童结核病和耐多药结核病病例未被发现。随着更多和更好的结核病数据和新的诊断工具的出现，未来的估计可以得到进一步的完善。
资助
美国国立卫生研究院、哈佛医学院赫尔穆特·沃尔夫冈·舒曼预防医学奖学金、哈佛医学院诺曼·E·津伯格奖学金以及布莱根妇女医院多西和霍华德·希亚特全球卫生公平与内科住院医师奖学金。
Zotero 插件