Diagnostics, surveillance and environmental drivers of TB in Borneo

结核病（TB）是继COVID-19之后的第二大传染病死亡原因。2021年，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（SDG）的健康目标（目标3.3）之一。在马来西亚，结核病相关死亡率正在下降，但不足以达到全球终结结核病战略的里程碑。马来西亚沙巴面临着历史上更高的结核病负担的特殊问题。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，但由于监测不完整，就医延迟和结核病治疗有限，这可能不是疾病分布的真实反映。在沙巴的内陆地区，获得医疗保健服务尤其困难，这在地形上具有挑战性，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牲畜疾病，但在其他国家，牛结核病从牛传播到野生动物的情况已得到充分记录，但在马来西亚，野生动物中的结核病/牛结核病监测在很大程度上被忽视。我们确实知道结核病感染在野生动物中可能很常见，例如，以前曾推迟过将圈养的猩猩放回自然栖息地。

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.