Getting to Zero New Tuberculosis Infections: Insights From the National Institutes of Health/US Centers for Disease Control and Prevention/Bill & Melinda Gates Foundation Workshop on Research Needs for Halting Tuberculosis Transmission.
Getting to Zero New Tuberculosis Infections: Insights From the National Institutes of Health/US Centers for Disease Control and Prevention/Bill & Melinda Gates Foundation Workshop on Research Needs for Halting Tuberculosis Transmission.
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DOI：
10.1093/infdis/jix311
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发表时间：
2017-11-03
期刊：
影响因子：
--
通讯作者：
Rustomjee R
中科院分区：
文献类型：
--
作者：
Shah NS;Kim P;Kana BD;Rustomjee R
Tuberculosis caused an estimated 1.4 million deaths in 2015 and now ranks as the leading infectious disease cause of mortality in the world [1]. An additional 1.7 billion people are currently infected with Mycobacterium tuberculosis and are at risk of developing active tuberculosis disease. The challenge to eliminate tuberculosis has never been more relevant and urgent. Unfortunately, efforts to bring this global epidemic under control have been hampered by inadequate understanding of the epidemiology, biology, and effective interventions that directly address tuberculosis transmission. Identifying the key drivers of transmission and appending interventions has thus far remained unattainable in many high-burden tuberculosis settings. The large reservoir of subclinical infections, the human immunodeficiency virus (HIV) coepidemic, and a rise in drug resistance make public health efforts to battle this disease complex. For example, in southern Africa, high rates of HIV infection have served as key drivers of the tuberculosis epidemic and have created a complex clinical situation with unique difficulties in diagnosis and tracking infectious individuals; these limitations have seriously hampered tuberculosis elimination in the region [1]. In the United States, intermittent outbreaks of tuberculosis continue to occur despite utilization of modern prevention interventions in a wellfunded healthcare system [2]. Globally, the modest declines (of 1.5%) in tuberculosis incidence between 2014 and 2015 fall markedly short of the targeted 4%–5% annual decline that is needed to achieve the 2020 milestones for the global End TB Strategy [3]. Of particular concern, the massive rollouts of new interventions targeted at individual patients, such as molecular diagnostics, preventative therapy, and antiretroviral treatment, and infrastructure investments in renovating healthcare facilities to reduce airborne disease spread have not resulted in sufficient epidemiological impact to meet global goals in reducing tuberculosis incidence [4, 5]. This highlights the need for sharply focused, evidence-led interventions and strategies tailored to individuals and communities, which are complemented by an ambitious implementation science agenda that rapidly translates new research findings to the field. Central to this process should be a paradigm shift toward limiting transmission with improved efficiency and effectiveness and the incorporation of strategies for overcoming the stigma and discrimination that continues to dilute the uptake and utilization of health services. The issue of transmission is at the core of nearly every infectious disease epidemic and begins with understanding among whom, where, and how a disease is being spread and how this spread is amplified by risk factors and drivers at an individual and community level. Conventionally, we know tuberculosis is spread from person to person through airborne transmission of tubercle bacteria via droplet nuclei expelled by an infectious person in close proximity of a susceptible individual. Sufficient sharing of air space is important for a successful chain of transmission. Only a small proportion of individuals infected with M. tuberculosis develop active TB disease; the large majority are able to contain or eliminate infection. Individuals with compromised immunity (eg, HIV, diabetes, older age, malnutrition) or underlying lung disease are at high risk of developing active tuberculosis disease. The development of active tuberculosis, which results in lung damage and respiratory insufficiency,
影响因子：
3.3
作者：
Mindra, Godwin;Wortham, Jonathan M.;Powell, Krista M.
通讯作者：
Powell, Krista M.