上传结核病解决方案.ppt

结核控制与潜伏感染 Frothingham R, et al.International Journal of Infectious Diseases (2005) 9, 297—311 疫苗：BCG, 新疫苗？ 潜伏感染的干预 DOTS DOTS－PLUS 新药？ New TB cases are driven by the reservoir of latently infected people. If we want to stop active TB cases, we need to eliminate this reservoir of infection. This “hidden epidemic” of people infected with latent TB is enormous. The growth in latent TB is becoming a clinical time bomb. We need to defuse this bomb by increasing our efforts to identify and treat latently infected people. 如何才能根除 TB? Active TB – 8 million new cases a year - Unfortunately just the tip of the iceberg Latent TB - the “hidden epidemic” -2 billion people infected 2015年前全球结核控制策略 3月24日全球结核日，新的STOP TB 计划公布 扩大DOTS TB-HIV 的治疗 MDR－TB的控制 新的诊断方法（2008年在不发达国家引入一种新的诊断方法） 新药（2010年上市2种新药） 新疫苗（2015年前上市一种新的疫苗） 发动全社会，战胜结核 2006：A year for cautious optimism in tuberculosis. Journal of infection (2006)53:1-4 Thank you * 我们看看中国耐药情况 * * 是WHO 2001年的报告 * 指 hidden epidemic 可能是造成发病率高的原因之一 * 结核病防治的面临的临床挑战与诊治进展 Tuberculosis: Back on the Immunologists’ Agenda. Immunity 24, 351–357, April 2006 Discovered by Robert Koch in 1882, exclusive human pathogen. Tuberculosis: Back on the Immunologists’ Agenda. Immunity 24, 351–357, April 2006 M. bovis bacillus Calmette–Guérin: that is, BCG. 化疗前时代 “once tuberculosis, always tuberculosis.” Waksman SA. The conquest of tuberculosis. London: Robert Haile Limited;1964 新发病例中的耐药结核比例WHO Primary resistance USA Rus Gem Henan Zhej ShanD Hongkong INH 8.0% 19.4% 5.7 24.0% 8.9% 11.3% 15.4% RFP 1.7% 7.9% 1.4% 14.6% 6.5% 3.8% 4.4% EMB 1.6% 7.0% 1.2% 7.7% 1.5% 1.7% 7.0% SM 5.9% 24.9% 4.7% 26% 9.0% 11.2% 6.8% MDR 1.2% 6.5% 0.9% 10.8% 1.4% 2.9% 3.4% Resistance in Previously treated USA Rus Gem Henan Zhej ShanD Hongkong INH 15.4% 42.7% 16.0 48.8% 44.3% 40.5% 17.4% RFP 8.0% 31.0% 6.6% 43.5% 45.0% 23.2% 11.6% EMB 4.1% 21.1% 3.9% 18.9% 17.9% 10.5% 6.0% SM 8.3% 53.4% 7.0% 50.7% 27.9% 34.5% 16.3% MDR 5.6% 26.7% 6.3% 34.4% 35.0% 19