新调查发现迄今最高的耐药结核发病率

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新调查发现迄今最高的耐药结核发病率
New survey finds highest rates of drug-resistant TB to date
26 FEBRUARY 2008 | WASHINGTON DC /GENEVA -- Multidrug-resistant tuberculosis (MDR-TB) has been recorded at the highest rates ever, according to a new report published today. The report presents findings from the largest survey to date on the scale of drug resistance in tuberculosis.

The report, "Anti-tuberculosis drug resistance in the world", is based on data collected between 2002 and 2006 on 90 000 TB patients in 81 countries. It found that extensively drug-resistant tuberculosis (XDR-TB), a virtually untreatable form of the respiratory disease, has been recorded in 45 countries.

The report also found a link between HIV infection and MDR-TB. Surveys in Latvia and Ukraine found nearly twice the level of MDR-TB among TB patients living with HIV compared with patients without HIV.

Based on the analysis of the survey data, WHO estimates there are nearly half a million new cases of MDR-TB a year, which is about 5% of nine million new TB cases of all types. The highest rate was recorded in Baku, the capital of Azerbaijan, where nearly a quarter of all new TB cases (22.3%) were reported as multidrug-resistant.

Proportions of MDR-TB among new TB cases were 19.4% in Moldova, 16% in Donetsk in Ukraine, 15% in Tomsk Oblast in the Russian Federation, and 14.8% in Tashkent in Uzbekistan. These rates surpass the highest levels of drug resistance published in the last WHO report in 2004. Surveys in China also suggest that MDR-TB is widespread there.

Frontal assault needed
"TB drug resistance needs a frontal assault. If countries and the international community fail to address it aggressively now we will lose this battle," said Dr Mario Raviglione, Director of the WHO Stop TB Department. "In addition to specifically confronting drug-resistant TB and saving lives, programmes worldwide must immediately improve their performance in diagnosing all TB cases rapidly and treating them until cured, which is the best way to prevent the development of drug resistance."

For the first time, the global survey includes analysis of XDR-TB. However, because few countries are currently equipped to diagnose it, limited data were available for this report.

The report also points to some successes. Thirteen years ago, Estonia and Latvia were singled out by WHO as drug-resistant TB "hotspots". Following a substantial investment and a sustained assault on MDR-TB, rates in these two Baltic countries are today stabilizing and TB case notification rates are falling.

The true scale of the problem also remains unknown in some pockets of the world. Only six countries in Africa - the region with the highest incidence of TB in the world - were able to provide drug resistance data. Other countries in the region could not conduct surveys because they lack the equipment and trained personnel needed to identify drug-resistant TB. "Without these data, it is difficult to estimate the true burden and trends of MDR-TB and XDR-TB in the region. It is likely there are outbreaks of drug resistance going unnoticed and undetected," said WHO TB expert Abigail Wright, the principal author of the report.

WHO estimates that US$ 4.8 billion is needed for overall TB control in low- and middle-income countries in 2008, with US$ 1 billion for MDR-TB and XDR-TB. But there is a total finance gap of US$ 2.5 billion, including a US$ 500 million gap for MDR-TB and XDR-TB.

"The threat created by TB drug resistance demands that we fill these gaps, as laid out in the Global Plan to Stop TB, a roadmap for halving TB prevalence and deaths compared with 1990 levels by 2015," said Dr Marcos Espinal, Executive Secretary of the Stop TB Partnership. "The Plan also calls for another imperative - sufficient resources for research to find new diagnostics, new drugs effective against resistant strains and an effective TB vaccine."


2008年2月26日 | | 华盛顿哥伦比亚特区/日内瓦 -- 今天发表的一份新报告显示，耐多药结核（MDR-TB）的发病率创下了有史以来的最高纪录。该报告介绍了迄今为止最大规模结核耐药性调查的新发现。

这份题为《全球结核耐药性控制》的报告，是依据2002至2006年间在81个国家对9万名结核病患者进行调查所收集的信息撰写的。该报告显示，有45个国家发现了目前尚无法治疗的广泛耐药结核（XDR-TB）。

报告还揭示了艾滋病毒感染与耐多药结核之间存在某种联系。在拉脱维亚和乌克兰开展的调查发现，与未感染艾滋病毒的结核病患者相比，感染艾滋病毒的结核病患者罹患耐多药结核的比率要高出近一倍。

根据调查数据的分析，世卫组织估计每年将近有50万例耐多药结核新增病例，约占每年900万各类结核新发病例的5%。发病率最高的地区是阿塞拜疆首都巴库，该地区近四分之一（22.3%）的新增结核病例属于耐多药结核。

在摩尔多瓦，耐多药结核在新增结核病例中的比例占19.4%，乌克兰的顿涅茨克为16%，俄罗斯联邦的托木斯克州则为15%，乌兹别克斯坦的塔什干为14.8%。这些比例超过了世卫组织上次于2004年公布的报告中的最高耐药水平。中国的调查也显示，耐多药结核在该国分布广泛。

需要正面抗击
世卫组织控制结核司司长Mario Raviglione博士说：“需要对结核耐药性展开正面抗击。如果各国和国际社会目前不着力解决这个问题，我们就会输掉这场战争。除了特别对付耐药性结核和挽救患者的生命，世界各地的规划必须立即在快速诊断并治愈各种结核病例方面取得更好的成绩，这是阻止耐药性发展的最佳途径。”

这次全球调查首次纳入了广泛耐药结核分析的内容。但是，由于目前只有少数国家拥有广泛耐药结核检测设备，因此报告获得的数据有限。

报告也列举了一些成功范例。13年前，爱沙尼亚和拉脱维亚被世卫组织单独列为耐药性结核“高发地区”。时至今日，通过大力投入和坚持不懈的抗击，这两个波罗的海国家的情况得到了控制，结核病例通报率日趋下降。

有些国家的情况究竟严重到何种程度仍不得而知。全球结核病发病率最高的非洲，只有六个国家能够提供耐药性方面的数据。该地区其他国家由于不具备诊断耐药性结核所需要的设备和专业人员，所以无法开展调查。这份报告的主撰稿人世卫组织结核病专家Abigail Wright说：“没有这些数据，就难以估计这些地区耐多药结核和广泛耐药结核的真正严重程度与发展趋势。很有可能暴发无人知晓和未发现的耐药疫情。”

世卫组织估计，2008年中低收入国家用于全面控制结核的资金需求达48亿美元，其中耐多药结核和广泛耐药结核需要10亿美元。但是，目前还存在着25亿美元的资金缺口，包括用于耐多药结核和广泛耐药结核的 5亿美元。

控制结核伙伴关系执行秘书Marcos Espinal博士表示：“结核耐药性的威胁，驱使我们来填补这个缺口。根据控制结核全球计划的路线图，到2015年要使结核病患病率和死亡率比1990年的水平降低一半。这份计划还呼吁采取另一项必要行动 — 筹集充足的资源来研究和开发新诊断方法、对付耐药性病菌的新药以及有效的结核疫苗。”

摘自WHO网站

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