Averting epidemics of extensively drug-resistant tuberculosis
Averting epidemics of extensively drug-resistant tuberculosis
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DOI：
10.1073/pnas.0812472106
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发表时间：
2009-05-05
影响因子：
11.1
通讯作者：
Galvani, Alison P.
中科院分区：
文献类型：
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作者：
Basu, Sanjay;Friedland, Gerald H.;Galvani, Alison P.
在南非的大多数省份，特别是在夸祖鲁-纳塔尔省发现了广泛耐药结核病，自2004年以来，该省已报告了数百例病例。我们使用数学模型分析了该地区广泛耐药结核病的传播动态，并观察到在许多南非社区的公共卫生条件下，广泛耐药结核病的医院内传播集群可能会出现以社区为基础的流行病。在夸祖鲁-纳塔尔，XDR TB的有效繁殖数可能在2左右。加强以社区为基础的病例发现和治疗似乎对减少传播至关重要。在延迟疾病表现和高系统需求的情况下，可能需要在基于社区的项目中采用改进的诊断方法，而不仅仅是在三级医院。使用分支过程数学，我们观察到，早期的，以社区为基础的药物敏感性测试和有效的XDR治疗可以帮助减少正在进行的传播，并降低XDR结核病在邻近地区流行的概率。
Extensively drug-resistant tuberculosis (XDR TB) has been detected in most provinces of South Africa, particularly in the KwaZulu-Natal province where several hundred cases have been reported since 2004. We analyzed the transmission dynamics of XDR TB in the region using mathematical models, and observed that nosocomial transmission clusters of XDR TB may emerge into community-based epidemics under the public health conditions of many South African communities. The effective reproductive number of XDR TB in KwaZulu-Natal may be around 2. Intensified community-based case finding and therapy appears critical to curtailing transmission. In the setting of delayed disease presentation and high system demand, improved diagnostic approaches may need to be employed in community-based programs rather than exclusively at tertiary hospitals. Using branching process mathematics, we observed that early, community-based drug-susceptibility testing and effective XDR therapy could help curtail ongoing transmission and reduce the probability of XDR TB epidemics in neighboring territories.