Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia.
Biological Anthropology and Comparative Anatomy Research Unit, School of Biomedicine, University of Adelaide, Australia; Institute of Evolutionary Medicine, University of Zurich, Switzerland.
Tuberculosis (Edinb). 2023 Dec;143S:102389. doi: 10.1016/j.tube.2023.102389. Epub 2023 Nov 25.
Humans and Mycobacterium tuberculosis have co-evolved together for thousands of years. Many individuals are infected with the bacterium, but few show signs and symptoms of tuberculosis (TB). Pharmacotherapy to treat those who develop disease is useful, but drug resistance and non-adherence significantly impact the efficacy of these treatments. Prior to the introduction of antibiotic therapies, public health strategies were used to reduce TB mortality. This work shows how these strategies were able to reduce TB mortality in 19th and 20th century populations, compared with antibiotic treatments. Previously published mortality data from historical records for several populations (Switzerland, Germany, England and Wales, Scotland, USA, Japan, Brazil and South Africa) were used. Curvilinear regression was used to examine the reduction in mortality before and after the introduction of antibiotic treatments (1946). A strong decline in TB mortality was already occurring in Switzerland, Germany, England and Wales, Scotland and the USA prior to the introduction of antibiotic treatment. This occurred following many public health interventions including improved sanitation, compulsory reporting of TB cases, diagnostic techniques and sanatoria treatments. Following the introduction of antibiotics, mortality rates declined further, however, this had a smaller effect than the previously employed strategies. In Japan, Brazil and South Africa, reductions in mortality rates were largely driven by antibiotic treatments that caused rapid decline of mortality, with a smaller contribution from public health strategies. For the development of active disease, immune status is important. Individuals infected with the bacterium are more likely to develop signs and symptoms if their immune function is reduced. Effective strategies against TB can therefore include enhancing immune function of the population by improving nutrition, as well as reducing transmission by improving living conditions and public health. This has been effective in the past. Improving immunity may be an important strategy against drug resistant TB.
人类和结核分枝杆菌已经共同进化了数千年。许多人感染了这种细菌，但只有少数人出现结核病（TB）的症状和体征。用于治疗发病者的药物疗法是有用的，但耐药性和不依从性会显著影响这些治疗的效果。在引入抗生素疗法之前，公共卫生策略被用于降低结核病死亡率。这项工作展示了与抗生素治疗相比，这些策略如何在 19 世纪和 20 世纪的人群中降低结核病死亡率。使用了来自几个国家（瑞士、德国、英格兰和威尔士、苏格兰、美国、日本、巴西和南非）历史记录中的先前发表的死亡率数据。使用曲线回归来检查引入抗生素治疗（1946 年）前后死亡率的降低情况。在引入抗生素治疗之前，瑞士、德国、英格兰和威尔士、苏格兰和美国的结核病死亡率已经在下降。这是在许多公共卫生干预措施之后发生的，包括改善卫生设施、强制报告结核病病例、诊断技术和疗养院治疗。在引入抗生素后，死亡率进一步下降，但这比以前采用的策略效果要小。在日本、巴西和南非，死亡率的降低主要是由于抗生素治疗导致死亡率迅速下降，公共卫生策略的贡献较小。对于活动性疾病的发展，免疫状态很重要。如果个体的免疫功能降低，感染细菌的个体更有可能出现症状和体征。因此，针对结核病的有效策略可以包括通过改善营养来增强人群的免疫功能，以及通过改善生活条件和公共卫生来减少传播。过去这是有效的。提高免疫力可能是对抗耐药性结核病的重要策略。
