耐异烟肼结核病的全球和地区负担
Global and Regional Burden of Isoniazid-Resistant Tuberculosis.
作者信息
Yuen Courtney M, Jenkins Helen E, Rodriguez Carly A, Keshavjee Salmaan, Becerra Mercedes C
机构信息
Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts;
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and.
出版信息
Pediatrics. 2015 Jul;136(1):e50-9. doi: 10.1542/peds.2015-0172. Epub 2015 Jun 1.
BACKGROUND
Isoniazid has been the backbone of tuberculosis chemotherapy for 6 decades. Resistance to isoniazid threatens the efficacy of treatment of tuberculosis disease and infection. To inform policies around treatment of tuberculosis disease and infection in children, we sought to estimate both the proportion of child tuberculosis cases with isoniazid resistance and the number of incident isoniazid-resistant tuberculosis cases in children, by region.
METHODS
We determined the relationship between rates of isoniazid resistance among child cases and among treatment-naive adult cases through a systematic literature review. We applied this relationship to regional isoniazid resistance estimates to estimate proportions of childhood tuberculosis cases with isoniazid resistance. We applied these proportions to childhood tuberculosis incidence estimates to estimate numbers of children with isoniazid-resistant tuberculosis.
RESULTS
We estimated 12.1% (95% confidence interval [CI] 9.8% to 14.8%) of all children with tuberculosis had isoniazid-resistant disease, representing 120,872 (95% CI 96,628 to 149,059) incident cases of isoniazid-resistant tuberculosis in children in 2010. The majority of these occurred in the Western Pacific and Southeast Asia regions; the European region had the highest proportion of child tuberculosis cases with isoniazid resistance, 26.1% (95% CI: 20.0% to 33.6%).
CONCLUSIONS
The burden of isoniazid-resistant tuberculosis in children is substantial, and risk varies considerably by setting. The large number of child cases signals extensive ongoing transmission from adults with isoniazid-resistant tuberculosis. The risk of isoniazid resistance must be considered when evaluating treatment options for children with disease or latent infection to avoid inadequate treatment and consequent poor outcomes.
背景
异烟肼60年来一直是结核病化疗的核心药物。对异烟肼产生耐药性会威胁到结核病和结核感染治疗的疗效。为了为儿童结核病和结核感染的治疗政策提供依据，我们试图按地区估算异烟肼耐药儿童结核病病例的比例以及儿童新发异烟肼耐药结核病病例的数量。
方法
通过系统的文献综述，我们确定了儿童病例与未接受过治疗的成人病例中异烟肼耐药率之间的关系。我们将这种关系应用于各地区异烟肼耐药率的估计值，以估算异烟肼耐药儿童结核病病例的比例。我们将这些比例应用于儿童结核病发病率的估计值，以估算异烟肼耐药结核病儿童的数量。
结果
我们估计，所有结核病儿童中有12.1%（95%置信区间[CI]为9.8%至14.8%）患有异烟肼耐药疾病，这代表2010年有120872例（95%CI为96628至149059例）儿童新发异烟肼耐药结核病病例。其中大多数病例发生在西太平洋和东南亚地区；欧洲地区异烟肼耐药儿童结核病病例的比例最高，为26.1%（95%CI：20.0%至33.6%）。
结论
儿童异烟肼耐药结核病的负担相当大，且风险因环境不同而有很大差异。大量儿童病例表明存在大量来自异烟肼耐药结核病成人患者的持续传播。在评估患有疾病或潜伏感染的儿童的治疗方案时，必须考虑异烟肼耐药的风险，以避免治疗不足及随之而来的不良后果。
Zotero 插件