Tuberculosis control and elimination in 2012 and beyondредакционная статья
Аннотация: Tuberculosis killed 1·45 million people in 2010 and about 500 000 people have drug-resistant disease. Treatment is lengthy, toxic, and costly. Moreover, diagnosis and drug-susceptibility testing are slow. On March 15, results from the Thibela TB study presented at a late-breaking session at the 2012 Conference on Retroviruses and Opportunistic Infections failed to show benefit of community-wide isoniazid preventive therapy compared with routine targeted therapy in 27 000 South African miners. The trial hoped to set a precedent for a control policy in high-risk groups such as the miners, up to 7% of whom develop tuberculosis every year because of the predisposing conditions of silicosis and HIV infection. Experts could therefore be forgiven for feeling gloomy ahead of World TB Day on March 24, but should not be. Despite a woeful funding gap in 2012 of US$1·7 billion, tuberculosis incidence is falling (from 9·4 million in 2009 to 8·8 million in 2010). 41 million people were treated with directly observed therapy in 1995–2009, and fewer people are now dying from the disease. Ten new or repurposed tuberculosis drugs are in phase 2–3 trials, which hopefully will reduce treatment times to about 4 months, compared with present multidrug-resistant tuberculosis regimens lasting 18–24 months. Faster treatment will greatly improve adherence, reduce transmission, and cut costs. Vaccine development has also received a boost of $220 million over 5 years, which was pledged to the non-profit vaccine developer Aeras by The Bill & Melinda Gates Foundation. Case detection is troublesome (it has plateaued at about 60%) but increased funding for Xpert MTB/RIF assays or use of low-cost alternatives, such as the point of care Determine TB-LAM, might improve detection rates in low-income settings. An ambitious target to be discussed on World TB Day is that of zero children dying from tuberculosis by 2015. To reach this goal, sustaining the gains seen so far and improving case finding will be vital. Some observers argue a broader vision is needed, pursuing zero infections, zero deaths, and zero stigma from tuberculosis for people of all ages. Both these objective will require commitment at the highest political levels and should be on the agenda when G20 leaders meet in Mexico in June. A sustainable agenda for tuberculosis control and researchIn 2010, The Lancet published a call to action on tuberculosis to all stakeholders.1 Since then, notable progress has been made towards international targets for achieving tuberculosis control.2 Annual incidence rates of tuberculosis and total numbers of patients with tuberculosis are slowly declining, deaths have been reduced by 40% compared with 1990, and a remarkable 46 million patients with tuberculosis have been cured since 1995.2 Full-Text PDF Can social protection improve tuberculosis control?Whether current approaches to tackle tuberculosis can be integrated with social protection strategies was the subject of a recent meeting in London. Pamela Das reports. Full-Text PDF Estonia lauded for tuberculosis control effortsEven though many challenges remain, Estonia's progress in tackling tuberculosis could become a model for its eastern European neighbours, say experts. John Donnelly reports. Full-Text PDF Beate Kampmann: research advocate for children with tuberculosisBeate Kampmann offers me triage over a video conference call, after hearing I've sprained my ankle. “Rest, ice, compression, elevation, and some ibuprofen.” We had been due to meet and talk about the neglected issue of childhood tuberculosis at her office in Imperial College, London, where she is Professor in Paediatric Infection and Immunity, but settle for meeting virtually over Skype instead. Full-Text PDF
Год издания: 2012
Авторы: The Lancet
Источник: The Lancet
Ключевые слова: Tuberculosis Research and Epidemiology
Другие ссылки: The Lancet (HTML)
PubMed (HTML)
PubMed (HTML)
Открытый доступ: closed
Том: 379
Выпуск: 9821
Страницы: 1076–1076