Diagnostics, surveillance and environmental drivers of TB in Borneo

结核病是仅次于新冠肺炎的第二大传染病死因。2021年，有1060万人患病，160万人死于结核病。到2030年结束结核病流行是联合国可持续发展目标(SDGs)的卫生目标(具体目标3.3)之一。在马来西亚，与结核病有关的死亡率正在下降，但还不足以达到全球结束结核病战略的里程碑。在历史上结核病负担较高的情况下，沙巴州马来西亚的问题尤为突出。在这里，结核病患者的地理热点目前与移民中心和密集的城市化人口中心相对应，但由于监测参差不齐、就医延迟和获得结核病护理的机会有限，这可能不是疾病分布的真实反映。在沙巴州内陆地区，获得医疗保健尤其困难，那里的地形具有挑战性，并以其标志性的野生动物而闻名。虽然牛结核病主要是一种家畜疾病，但牛结核病在其他国家也有很好的记录，但在马来西亚，对野生动物的结核病/牛结核病监测基本上被忽视了。然而，我们确实知道，结核病感染很可能在野生动物中很常见，例如，以前曾推迟圈养猩猩返回自然栖息地的释放。

Tuberculosis (TB) is the second leading cause of death from infectious disease after COVID-19. In 2021, 10.6M fell ill and 1.6M died from TB. Ending TB epidemics by 2030 is among the health targets (Target 3.3) of the United Nations Sustainable Development Goals (SDGs). In Malaysia, TB related mortality is reducing but not sufficiently to meet the global End TB Strategy milestones. Sabah Malaysia has particular problems with historically higher burdens of TB. Here, geographic hotspots of TB patients currently correspond with migration hubs and dense urbanised population centres, but with patchy surveillance, delayed health seeking and limited access to TB care this might not be a true reflection of disease distribution. Access to healthcare provision is particularly difficult within Sabah's interior, which is topographically challenging and renowned for its iconic wildlife. While bovine TB is primarily a disease of livestock, spread of bTB from cattle to wildlife is well documented in other countries, but in Malaysia TB/bTB surveillance in wildlife has been largely neglected. We do know though that TB infections are likely common in wildlife and for example have previously delayed the release of captive orangutans back to their natural habitats.