Controversies and Unresolved Issues in Tuberculosis Prevention and Control: A Low-Burden-Country Perspective
Controversies and Unresolved Issues in Tuberculosis Prevention and Control: A Low-Burden-Country Perspective
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DOI：
10.1093/infdis/jir886
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发表时间：
2012-05-15
影响因子：
6.4
通讯作者：
Zumla, Alimuddin
中科院分区：
文献类型：
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作者：
Abubakar, Ibrahim;Stagg, Helen R.;Zumla, Alimuddin
尽管结核病在大多数高收入国家的发病率有所下降，但在不久的将来没有消失的迹象。虽然大多数西欧国家的监测数据显示，过去几十年来结核病发病率相对稳定地下降，但有些国家报告说，近年来结核病发病率上升或下降速度减缓。疾病负担现在不成比例地影响到移民、无家可归者和囚犯等高危群体。鉴于病例集中在城市地区和高风险的贫困群体，对一般人群采取的干预措施可能效率不高，但对高风险群体采取的干预措施可能具有很高的成本效益。在这篇文章中，我们研究了一些有争议的因素，结核病预防和控制在低负担国家，并建议进一步研究的问题。特别是，我们评估了目前的证据，卡介苗的保护期，移民和难以接触的群体的筛查，以及使用预防性治疗的接触传染性耐多药结核病的情况。这一分析是从结核病负担低、高收入国家试图消除结核病的角度提出的。
Despite declining incidence in most high-income countries, tuberculosis shows no signs of disappearing in the near future. Although surveillance data from most Western European countries show relatively stable declines in the rate of tuberculosis over the past several decades, some have reported either an increasing rate or a decelerating pace of reduction in recent years. The burden of disease now disproportionately affects high-risk groups such as migrants, homeless persons, and prisoners. In view of the concentration of cases in urban areas and high-risk deprived groups, interventions that may not be efficient when applied to the general population may be highly cost effective when targeted at high-risk groups. In this article, we examine some controversial elements of tuberculosis prevention and control in low-burden countries and recommend issues for further research. In particular, we assess current evidence on the duration of protection by BCG vaccine, the screening of migrants and hard-to-reach groups, and the use of preventive therapy for contacts of cases of infectious multidrug-resistant tuberculosis. This analysis is presented from the perspective of low-tuberculosis-burden, high-income countries attempting to eliminate tuberculosis.