Centre for Infectious Disease Epidemiology, Research Department of Infection and Population Health, University College London, London, UK; Wellcome Trust Africa Centre for Population Health, Mtubatuba, South Africa, London School of Hygiene & Tropical Medicine, London, UK.
Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK; Tuberculosis Centre, London School of Hygiene & Tropical Medicine, London, UK; Karonga Prevention Study, Chilumba, Malawi.
Lancet Infect Dis. 2016 Feb;16(2):227-38. doi: 10.1016/S1473-3099(15)00499-5. Epub 2016 Jan 26.
Unacceptable levels of Mycobacterium tuberculosis transmission are noted in high burden settings and a renewed focus on reducing person-to-person transmission in these communities is needed. We review recent developments in the understanding of airborne transmission. We outline approaches to measure transmission in populations and trials and describe the Wells-Riley equation, which is used to estimate transmission risk in indoor spaces. Present research priorities include the identification of effective strategies for tuberculosis infection control, improved understanding of where transmission occurs and the transmissibility of drug-resistant strains, and estimates of the effect of HIV and antiretroviral therapy on transmission dynamics. When research is planned and interventions are designed to interrupt transmission, resource constraints that are common in high burden settings-including shortages of health-care workers-must be considered.
在高负担环境中，结核分枝杆菌的传播水平是不可接受的，需要重新关注这些社区中人与人之间的传播。我们回顾了对空气传播理解的最新进展。我们概述了用于衡量人群和试验中传播的方法，并描述了威尔斯-莱利方程，该方程用于估计室内空间的传播风险。目前的研究重点包括确定结核病感染控制的有效策略、更好地了解传播发生的地点和耐药菌株的传染性、以及估计 HIV 和抗逆转录病毒疗法对传播动态的影响。当计划研究和设计干预措施以阻断传播时，必须考虑到高负担环境中常见的资源限制，包括卫生保健工作者的短缺。
