Drug-resistant tuberculosis in the WHO Western Pacific Region
Drug-resistant tuberculosis in the WHO Western Pacific Region
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DOI：
10.5365/wpsar.2014.5.4.007
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发表时间：
2014-10-01
影响因子：
1
通讯作者：
Nishikiori, Nobuyuki
中科院分区：
文献类型：
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作者：
Islam, Tauhid;Hiatt, Tom;Nishikiori, Nobuyuki
目的：回顾世界卫生组织（WHO）西太平洋地区结核病耐药性和耐药结核病规划管理的最新信息。方法：我们分析了2007年至2013年各国向WHO报告的常规数据，重点关注以下数据：监测和调查耐药性、耐药性结核病的管理以及与耐多药结核病管理有关的筹资。在西太平洋地区，4%（95%置信区间[CI]：3-6）（95% CI：18-26），这意味着在2013年，估计有71 000例（95%CI：47 000-94 000）该地区报告的肺结核病例中的耐多药结核病例。在新的和以前接受过治疗的结核病例中，药物敏感性测试的覆盖率分别为3%和20%。2013年，通报了11，153例病例，占估计耐多药结核病例的16%。在报告的病例中，6926例或62%的病例入组治疗。在所有登记的耐多药结核病例中，34%的病例接受了二线DST治疗，其中13%对氟喹诺酮类（FQ）和/或二线注射剂耐药。2011年耐多药结核病队列显示，治疗成功率为52%。在过去五年中，病例通报和登记增加了五倍多，但通报和登记之间的差距扩大了。讨论：耐多药结核病例的发现和登记呈上升趋势，这表明已准备好在国家一级扩大耐药结核的方案管理。然而，仍然存在相当大的挑战。
Objective: To review the latest information about tuberculosis (TB) drug resistance and programmatic management of drug-resistant TB in the Western Pacific Region of the World Health Organization (WHO).Methods: We analysed routine data reported by countries to WHO from 2007 to 2013, focusing on data from the following: surveillance and surveys of drug resistance, management of drug-resistant TB and financing related to multidrug-resistant TB (MDR-TB) management.Results: In the Western Pacific Region, 4% (95% confidence interval [CI]: 3-6) of new and 22% (95% CI: 18-26) of previously treated TB cases were estimated to have MDR-TB; this means that in 2013, there were an estimated 71 000 (95% CI: 47 000-94 000) MDR-TB cases among notified pulmonary TB cases in this Region. The coverage of drug susceptibility testing (DST) among new and previously treated TB cases was 3% and 20%, respectively. In 2013, 11 153 cases were notified-16% of the estimated MDR-TB cases. Among the notified cases, 6926 or 62% were enrolled in treatment. Among all enrolled MDR-TB cases, 34% had second-line DST and of these, 13% were resistant to fluoroquinolones (FQ) and/or second-line injectable agents. The 2011 cohort of MDR-TB showed a 52% treatment success. Over the last five years, case notification and enrolment have increased more than five times, but the gap between notification and enrolment widened.Discussion: The increasing trend in detection and enrolment of MDR-TB cases demonstrates readiness to scale up programmatic management of drug-resistant TB at the country level. However, considerable challenges remain.