Abstract
Consensus document to advocate and ensure proper implementation of WHO recommendations on TB elimination in Italyhttp://ow.ly/BHJC307S2U4
2014年,世界卫生议会认可了新的结核病策略,该战略旨在在2035年将疾病的全球发病率降低90%[1]。
The World Health Organization (WHO) published, in 2015, a framework for tuberculosis (TB) elimination,例如。在低结核病发病率国家(TB发病率低于每10万人口的10例),如何达到消除结核病(少于百万人口的结核病)的路线图(少于一个人口)[2]。The document had been jointly promoted by WHO and the European Respiratory Society in Rome in July 2014, followed by a consultation with representatives of low TB incidence countries and partner organisations. In this editorial, we present a roadmap for Italy which could also be used as a model for other low TB incidence countries in Europe.
为了到2050年到达TB,意大利首先需要降低结核病的发生率,以达到结核病前淘汰前的阈值(<10案例)到2035年[2]。
Over the past 70 years, TB incidence (as derived from TB notifications) in Italy has remained rather stable at around seven cases per 100 000 population [3], or 70 cases per million inhabitants. The rapid decline of TB cases among native Italians and the slower decline among foreign-born individuals has slowly modified the epidemiology of TB in Italy. According to a survey done by Istituto Superiore di Sanità, Rome (unpublished data), aimed at ensuring quality control in reference laboratories, out of 13 030 strains examined between 2008 and 2014, 47% belonged to native Italians (6161) and 53% to foreign-born individuals (6869). Interestingly, out of 410 multidrug-resistant TB (MDR-TB) strains, 77 were identified among native Italians (19%) and 333 among foreign-born individuals (81%).
In Italy and other low TB incidence countries in Europe, the goal of TB elimination is plausible [2];它要求卫生部确定优先干预措施,并通过适当的指标促进预算的结核病控制和消除计划[4–6]。
Mathematical modelling indicates that, in order to reach TB elimination by the fixed deadline, the present annual incidence decline in Europe (2–5%) should gradually increase to approach the level of 20% [2,3,7]。According to WHO, this is possible if available prevention, diagnostic and treatment weapons are optimally implemented [2,8,9]。这些包括新一代快速诊断和较短的治疗结核病(包括其抗性形式)和潜在结核病感染(LTBI)[10,11]。
例如,基于结核病控制和消除干预措施的“激进方法”的设置可获得,导致结核病发生率的迅速降低,并朝着淘汰前阶段发展[12,13]。
This consensus (and call for action) document is aimed at promoting discussion between TB experts, administrators and policymakers in order to ensure that WHO recommendations on TB elimination are implemented in Italy.
In agreement with the principles of the TB elimination framework, we summarise eight core interventions and activities to be included in a roadmap for TB elimination in Italy, which were developed by consensus of representatives of different Italian and international organisations (including the European Respiratory Society) in a meeting organised by the Italian Respiratory Society (SIP/IRS) in Milan on October 5, 2016 (表格1)。
1)具有优质抗结核服务的政治承诺。意大利的结核病控制目前是基于21个区域计划,这些计划不一定与最新的WHO政策文件保持一致。进一步工作的主要领域是LTBI的管理以及参考中心外的快速诊断测试。结核病控制和消除活动需要充分资助。
2)改进监视,允许对程序进行质量监控和评估。意大利应优化其将完整的监视数据及时提交给谁和欧洲疾病预防和控制中心的能力,同时实施一致的国家分子流行病学监测计划。
3) Focus on groups at higher risk of developing TB. A periodic identification of the groups where targeting TB elimination efforts is necessary, based on surveillance data.
4)管理migration-relat发展计划ed issues. The number of TB cases among foreign-born individuals has increased and is, today, higher than that of native Italians. In addition, the important migration flow to Europevialand or sea (Italy is among the main migrants' host countries) needs a coherent and coordinated approach [14–16]。
5) Prioritisation of LTBI testing and treatment in high-risk groups. Diagnosis and treatment of LTBI is the core intervention needed to achieve TB elimination, as it will reduce the “reservoir” of infected individuals from which future cases will be generated [2]。
6)预防和治疗MDR-TB。尽管这些案例的绝对数量不高[17], the complexity and costs of their management, and the potentialities for further nosocomial transmission, call for a targeted approach [2]。应对MDR-TB的治疗结果监测。
7) Fostering of research on new vaccines, diagnostics and drugs. Italy needs to contribute to the global effort towards the acquisition of basic knowledge leading to the development of new anti-TB tools (basic research) and on their optimal implementation (implementation research).
8) Global and European coordination of TB elimination efforts. It is common experience that TB does not respect borders and the best way to maintain future generations of TB experts is to actively cooperate in international TB control and elimination activities.
We are confident that TB elimination can be within reach if Italy, together with the other low TB incidence countries in and outside Europe, will seriously embark in a comprehensive plan that incorporates all the core activities discussed above.
Footnotes
利益冲突:没有声明。
The views and opinions expressed in this document are those of the authors and do not necessarily reflect the views and opinions of their institutes.
- ReceivedNovember 14, 2016.
- AcceptedDecember 5, 2016.
- Copyright ©ERS 2017