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[1982年全球结核病所带来的问题]

[Problems posed by tuberculosis in the world in 1982].

作者信息

Chaulet P, Khaled N A, Amrane R

出版信息

Rev Fr Mal Respir. 1983;11(2):79-110.

PMID:6856942
Abstract

One hundred years after the discovery of the tubercle bacillus the struggle against tuberculosis still poses numerous problems on a world scale. Each year, 10 million new cases appear: nearly five million are highly contagious; 95% of these cases come from developing countries. The official notification system currently in force is imperfect but a reckoning of the annual infection risk, from a methodical enquiry into tuberculous disease gives exact information on the size of the problem and its evolutionary time scale in each country. This is the best epidemiological index currently available. The technical problems of the struggle against tubercle are resolved in theory: the selective detection of groups at risk, centered on a network of bacteriology laboratories enables identification of all the sources of infection; chemotherapy, becoming safer and safer, with a duration reduced to 6 or 9 months at the maximum and curing practically 100% of the patients; properly performed BCG vaccination reduces the risk of infantile tuberculosis. Operational problems remain the most serious. The greatest difficulties are seen in countries with the highest prevalence: they are linked to a global shortage of resources but also at times a poor utilisation of the resources available. A concerted international action could render antituberculous drugs and the appropriate sanitary technology to all countries. With a judicious use of available information and means each country could today achieve an effective national antituberculous programme.

摘要

在结核杆菌被发现一百年后,全球范围内与结核病的斗争仍面临众多问题。每年有1000万新病例出现:其中近500万具有高度传染性;这些病例中有95%来自发展中国家。目前实施的官方通报系统并不完善,但通过对结核病进行系统调查得出的年度感染风险估算,能提供有关每个国家该问题规模及其演变时间尺度的确切信息。这是目前可用的最佳流行病学指标。理论上,与结核病作斗争的技术问题已得到解决:以细菌学实验室网络为核心,对高危人群进行选择性检测,能够识别所有感染源;化疗越来越安全,疗程最长减至6或9个月,几乎能治愈100%的患者;正确接种卡介苗可降低婴儿患结核病的风险。实际操作问题仍然最为严重。在患病率最高的国家,困难最为突出:这既与全球资源短缺有关,也有时与可用资源利用不佳有关。协调一致的国际行动可为所有国家提供抗结核药物和适当的卫生技术。如今,每个国家若能明智地利用现有信息和手段,就能制定出有效的国家结核病防治计划。

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