Lancet:我国感染性疾病控制与新发传染病

细菌耐药

Infectious diseases remain the major causes of morbidity and mortality in China despite substantial progress in their control. China is a major contributor to the worldwide infectious disease burden because of its population size. The association of China with the rest of the world through travel and trade means that events in the country can aff ect distant populations. The ecological interaction of people with animals in China favours the emergence of new microbial threats. The public-health system has to be prepared to deal with the challenges of newly emerging infectious diseases and at the same time try to control existing diseases. To address the microbial threats, such as severe acute respiratory syndrome, the government has committed substantial resources to the implementation of new strategies, including the development of a real-time monitoring system as part of the infectious-disease surveillance. This strategy can serve as a model for worldwide surveillance and response to threats from infectious diseases.

细菌耐药

感染控制的内容能上Lancet还是很少见的，虽然是2008年的文献了，还是值得我国感控人员一读。

这篇文章对感染性疾病分为以下几种情况来阐述：

Panel 1: List of notifiable diseases in China, 1970–2008
Present notifi able diseases*
• Plague†
• Epidemic cerebrospinal meningitis (mainly
meningococcal meningitis)†
• Scarlet fever†
• Epidemic encephalitis B (Japanese encephalitis)†
• Malaria†
• Epidemic haemorrhagic fever (hantavirus haemorrhagic
fever with renal syndrome)†
• Hook-worm diseases†
• Brucellosis†
• Rabies†
• Anthrax†
• Hepatitis (A,B,C,E, other)†
• Diphtheria†
• Pertussis†
• Poliomyelitis†
• Measles†
• Dysentery†
• Cholera†
• Typhoid and paratyphoid†
• Dengue fever (1990)
• Gonorrhoea (1990)
• Syphilis (1990)
• AIDS (1990)
• Tetanus neonatorum (1996)
• HIV infection (1997)
• Tuberculosis (1997)
• Severe acute respiratory syndrome (2004)
• Schistosomiasis (2005)
• Human avian infl uenza (2005)
Past notifi able diseases (notifi ed from 1970–89)
• Smallpox
• Relapsing fever
• Tsutsugamushi disease
• Forest encephalitis (tickborne encephalitis)
• Infl uenza
Past notifi able diseases (notifi ed from 1970–2004)
• Ship-fever (mainly louse-borne typhus)
• Kala-azar (visceral leishmaniasis)
*Notification began in 1970, unless otherwise shown within parentheses. †One of the
18 consistently notifi able infectious diseases reported from 1970 to 2007.

细菌耐药

我国感染性疾病控制的主要措施：
Panel 2: Specific strategies for infectious disease control in China          
Central government leadership is essential for local governmental response The amount of central government attention to infectious diseases largely determines the amount of local governmental response.          
Local governments are accountable for achieving disease control targets Local government officials will support and prioritise control of infectious diseases when they are given specific disease control targets and know they will be held accountable for achieving them.          
Central government increases local government funding for control of infectious diseases          
Such funding provides local government with the necessary resources to implement disease control programmes, and serves as an example and incentive to increase local funding.          
Innovative technologies and approaches to improve disease control Perhaps the best example is the use of the new internet-based disease reporting system to improve the reporting and follow-up of infectious diseases.          
Pilot or demonstration projects to develop national disease control policies These projects help develop the best approach within the Chinese context, including the adaptation of international best practices; frequently needed to convince policy makers of the feasibility and eff ect of specifi c approaches.          
Contribution of international collaboration          
International collaborative projects have provided the needed funding to implement disease control programmes. More importantly, they have trained many health professionals in international best practices and management approaches.          

细菌耐药

我国1970-2007年感染性疾病的发病率
Trends in incidence (cases per 100 000 population per year) of notifiable infectious diseases in China during 1970–2007

细菌耐药

我国1970-2007年感染性疾病的死亡率：
Trends in deaths (per 100 000 population per year) from notifi able infectious diseases in China during 1970–2007

细菌耐药

病原菌耐药的发展
Development of drug-resistant diseases
The increase in drug resistance for many types of
infections in China (eg, bacterial, viral, parasitic)
complicates the control strategies for these diseases.
Drug-resistance is most common with sexually transmitted
diseases, tuberculosis, and HIV/AIDS.48,49 The
resistance of HIV to fi rst-line antiretroviral drugs is
increasing among patients with HIV/AIDS in China.49
About one in ten cases of tuberculosis identifi ed in the
2000 national prevalence survey had multidrug-resistant
disease. Several provinces have some of the highest
rates of this form of tuberculosis in the world, and
extensively drug-resistant tuberculosis has also been
reported.50,51
Inappropriate prescribing of antimicrobial drugs by
health-care providers and the incorrect intake of drugs by
patients contribute to the development of drug-resistant
microbes. Increased eff orts will be needed to educate
health-care providers, patients, and their family members
to address these diffi culties. Treatment of resistant
infections typically requires drugs that are more toxic,
and more expensive than those used to treat non-resistant
infections, which makes the control of present and future
infectious diseases diffi cult (and, in some cases,
impossible). The drug-resistance patterns of specifi c
diseases with time will need to be monitored by
laboratories to decide on the most cost-eff ective treatment
strategy for each locality and to make necessary changes
in strategy as resistance patterns change.

细菌耐药

2009年，Lancet又针对本文发表了一篇评论：

中国抗生素耐药---未来巨大的挑战
Antibiotic resistance in China--a major future challenge.

The Lancet, Volume 373, Issue 9657, Page 30, 3 January 2009

Original Text
Andreas Heddini a, Otto Cars b, Sun Qiang c, Göran Tomson d
Longde Wang and colleagues (Nov 1, p 1697)1 outline the future challenges posed by infectious diseases in the Chinese context. Infectious diseases remain a major problem in China today and Wang and colleagues provide a comprehensive review of current and emerging infectious diseases and their control. Strikingly, however, the increasing threat of antibiotic resistance is only briefly mentioned.
The situation with respect to overuse of antibiotics and antibiotic resistance in China is severe.2 Several factors are involved, including a health system with strong financial incentives for drug prescribing.3 Around 75% of patients with seasonal influenza are estimated to be prescribed antibiotics, and the rate of antibiotic prescription to inpatients is 80%.4 In a study of resistance patterns of several common bacteria in China in 1999 and 2001,5 the mean prevalence of resistance among hospital-acquired infections was as high as 41% and that among community-acquired infections was 26%. China also has the world's most rapid growth rate of resistance (22% average growth in a study spanning 1994 to 2000).5
The faceless threat of antibiotic resistance is likely to be one of the greatest challenges to global health during the 21st century, with a direct effect on health indicators in low-income, middle-income, and high-income countries. It is positive that China's new health system reform suggests a pharmaceutical policy that includes a strategy for rational drug use. What happens in China matters for the world.
We declare that we have no conflict of interest.
References
1 Wang L, Wang Y, Jin S, et al. Emergence and control of infectious diseases in China. Lancet 2008; 372: 1598-1605. Summary | Full Text | PDF(195KB) | CrossRef | PubMed
2 Reynolds L, McKee M. Factors influencing antibiotic prescribing in China: an exploratory analysis. Health Policy 200810.1016/j.healthpol.2008.09.002. published online Oct 13. PubMed
3 Sun Q, Santoro MA, Meng Q, Liu C, Eggleston K. Pharmaceutical policy in China. Health Aff 2008; 27: 1042-1050. PubMed
4 Zheng Y, Zhou Z. The root causes of the abuse of antibiotics, harm and the rational use of the strategy. Hospital Management Forum 2007; 123: 23-27. (in Chinese). PubMed
5 Zhang R, Eggleston K, Rotimi V, Zeckhauser RJ. Antibiotic resistance as a global threat: evidence from China, Kuwait and the United States. Global Health 2006; 2: 6. PubMeda Centre for Microbiological Preparedness, Swedish Institute for Infectious Disease Control, Nobels väg 18, SE-171 82 Solna, Sweden
b Action on Antibiotic Resistance, Uppsala University, Uppsala, Sweden
c Center for Health Management and Policy, Shandong University, Jinan, China
d Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

ffli

多谢老师分享，文章发表时间早于2009年，转眼5年又过去了

ganxiaobao

多谢老师分享，文章发表时间早于2009年