吴仪副总理在全国结核病防治工作电视电话会议上的讲话

今年国务院确定将艾滋病、血吸虫病和结核病作为重点控制的重大传染病。上半年，我们召开了全国防治艾滋病工作会议，也召开了全国的血吸虫病防治工作会议，对这两个病的防治已经都作了部署，今天我们再次召开全国的结核病防治工作电视电话会议，专门部署对结核病的预防和控制工作。     

构建智慧化网络 助力结核病防治

功能完备的结核病防治服务体系是实现高质量结核病防治服务的前提和基础，在不断发展的大数据、人工智能等信息技术背景下，统筹规划，逐步构建管理科学、运行高效的结核病防治服务体系，对于确保结核病防治工作高质量、可持续发展至关重要。本文结合我国当前社会经济发展现状和结核病防治新形势，强调了构建智慧化结核病防治网络的必要性，阐述了如何构建智慧化网络，并以三大行动为实践案例解读如何充分发挥智慧化网络在结核病防治工作中的作用，从而全面提升结核病防治工作效率和质量，助力结核病防治目标的实现。     

我国结核病防治地方立法现状分析

控制结核病流行是实施健康中国战略，维护我国人民生命健康权益的必然要求。为此，我国不少地方制定了结核病防治法规、规章、规范性文件，对结核病防治的政府责任、结核病防控措施、结核病患者的管理措施、法律责任等方面作出规定。但是我国仍面临着结核病防治立法的挑战，一些结核病高发省份仍没有结核病防治的地方立法，现有的一些地方法规、规章和规范性文件也亟需修订等。本文基于对现有的地方结核病防治法规、规章和规范性文件的分析，提出应对前述挑战的建议。     

山东省结核病防治策略评价

本文在回顾其发展，分析其执行效果的基础上，对山东省近几十年结核病防治策略的成就进行了总结。作者认为，策略是成功的，山东省的结核病疫情得到了有效控制，结核病防治技术进入规范化管理的新阶段，加速了结核病防治工作观念的转变。     

山东省结核病防治策略评价

本文在回顾其发展，分析其执行效果的基础上，对山东省近几十年结核病防治策略的成就进行了总结。作者认为，策略是成功的，山东省的结核病疫情得到了有效控制，结核病防治技术进入规范化管理的新阶段，加速了结核病防治工作观念的转变。     

山西省结核病防治计划实施效果分析（2001-2009）

为加强全省结核病防治（简称“结防”）工作，山西省政府根据《全国结核病防治规划（2001-2010年）》，制定并下发了《山西省结核病防治计划（2001-2010年）》。笔者对2001-2009年山西省结核病防治计划执行情况进行了评估，旨在总结全省结核病防治计划实施的成功经验，分析存在的困难和问题，为今后制定全省结核病可持续发展政策提供依据。     

某大中专院校学生结核防治知识、信念、行为调查分析

结核病是一种严重危害人类健康的慢性传染性疾病。我国是全球22个结核病高负担国家之一，全国结核病发病率和死亡率均位居法定报告传染病之首，为了解在校学生对结核病防治知识掌握程度以及相关信念和行为状况，为更好地在学校开展结核病防治健康促进提供科学依据，我们于2008年4月对鹰潭市某大中专院校进行了有关结核病防治知识、信念、行为问卷调查，现将调查情况报告如下。     

严重耐多药结核病研究最新进展

近年来，严重耐多药结核病（extensively drug resistant tuberculosis，XDR-TB）的流行与传播使本已严峻的全球结核病防治形势变得更为紧迫，引起了各国结核病防治工作者的极大关注和不安。严重耐多药结核病的发生与发展暴露了世界结核病控制措施的薄弱和不足，也给全球公共卫生带来了前所未有的挑战。世界各国结核病防治专家正在追寻严重耐多药结核病产生的原因，认识其对人类的危害，并寻找控制其发生与发展的可能对策，     

新疆喀什、和田、阿克苏、克州结核病控制工作综合调查分析

喀什、和田、克州、阿克苏4地州是新疆结核病高发地区，其每年发病例数占全疆70％以上，是自治区结核病防治工作的重点地区，自2002年以来自治区先后在全疆范围内实施了世行贷款／英国赠款中国结核病控制项目、全球基金结核病防治项目和中央转移支付结核病防治项目，该区域结核病防治工作取得了很大进展，为全面掌握当地结核病防治现况，     

山西省运城地区垣曲县农村医师结核病防治知识知晓率的调查报告

2003年7月山西省运城安国结核病医院对运城地区13个区、县3500名农村医师进行结核病防治知识培训，以协助区、县结核病防治机构，圆满完成卫生部“全球基金控制结核病免费治疗项目”。该项目启动前对其中1个县——垣曲县155名农村医师结核病防治知识知晓率进行了调查，以便制定培训计划。培训后又进行了1次调查，以了解培训效果。现将结果报告如下：     

Modeling the effects of strain diversity and mechanisms of strain competition on the potential performance of new tuberculosis vaccines

While bacillus Calmette-Guérin vaccination plays an important role in reducing the morbidity of tuberculosis (TB) infection during childhood, new tuberculosis vaccines are necessary to disrupt the transmission of disease and improve global control of this pathogen. Growing evidence of the presence of meaningful Mycobacterium tuberculosis strain diversity, coupled with the possibility that new vaccines may differentially protect against infection or disease with circulating M. tuberculosis strains, suggest that these vaccines may have complicated effects on disease dynamics. We use a mathematical model to explore the potential effects of strain diversity on the performance of vaccines and find that vaccines offer great promise for improving tuberculosis control, but the expected benefits of mass vaccination will be eroded if strain replacement with M. tuberculosis variants that are not effectively targeted by vaccines occurs. Determining the likelihood of strain replacement will require additional knowledge of the strain specificities of current vaccine candidates, and an improved understanding of the mechanisms of strain interaction, which are responsible for maintaining the diversity of M. tuberculosis within communities.     

Will DOTS do it? A reappraisal of tuberculosis control in countries with high rates of HIV infection.

In 1993 the WHO declared tuberculosis a global emergency, and subsequently introduced the DOTS strategy, a technical and management package based on earlier work of the IUATLD and international experience with directly observed therapy. Despite successful implementation of most of the elements of this strategy in several African countries and settings, tuberculosis case rates continue to escalate where the prevalence of HIV infection is high. We explore possible reasons for the failure to control tuberculosis even in the context of tuberculosis programmes that have been considered models for others to emulate. In many African countries half or more of tuberculosis patients are now HIV-infected; in such settings, the overall epidemiology of tuberculosis is disproportionately affected by what happens in the HIV-infected subpopulation of the community. Persons with HIV infection are at increased risk of rapid progression following primary infection or re-infection, and also from reactivation of latent infection with Mycobacterium tuberculosis. More intensive strategies need to be targeted to the HIV-infected to interrupt on-going transmission (active and passive case detection; prevention of nosocomial transmission) and reactivation (preventive therapy). The high burden of other HIV-related disease in patients with tuberculosis, such as other bacterial infections, toxoplasmosis and other manifestations of AIDS, require that tuberculosis programmes integrate their activities better with those of HIV/AIDS programmes, including those for provision of HIV/AIDS care. Enhanced epidemiological surveillance is required to follow tuberculosis trends in the HIV-positive and negative sub-populations of communities, which may respond differently to control efforts. Strategies for tuberculosis control programmes in countries of high and low HIV prevalence cannot be the same, but must take into account the epidemiology of HIV infection. HIV/AIDS in Africa poses severe challenges of purpose and identity to tuberculosis control programmes, which have not adapted to the altered realities of the HIV/AIDS era. DOTS alone is unlikely to control tuberculosis in sub-Saharan Africa; one major achievement of DOTS when implemented, however, has been its apparent ability to limit the development and spread of drug resistance.     

Determinants of cluster distribution in the molecular epidemiology of tuberculosis

Recently developed molecular techniques have revolutionized the epidemiology of tuberculosis. Multiple studies have used these tools to examine the population structure of Mycobacterium tuberculosis isolates in different communities. The distributions of clusters of M. tuberculosis isolates in these settings may variously reflect social mixing patterns or the differential fitness of specific clones of the organism. We developed an individual-based microsimulation of tuberculosis transmission to explore social and demographic determinants of cluster distribution and to observe the effect of transmission dynamics on the empiric data from molecular epidemiologic studies. Our results demonstrate that multiple host-related factors contribute to wide variation in cluster distributions even when all strains of the organism are assumed to be equally transmissible. These host characteristics include interventions such as chemotherapy, vaccination and chemoprophylaxis, HIV prevalence, the age structure of the population, and the prevalence of latent tuberculosis infection. We consider the implications of these results for the interpretation of cluster studies of M. tuberculosis as well as the more general application of microsimulation models to infectious disease epidemiology.     

Recent developments in epidemiology, treatment, and diagnosis of tuberculosis

The resurgence in cases of active tuberculosis in North America in the past decade has prompted increases in funding for tuberculosis treatment, research, and education. As a result, the number of new cases of tuberculosis has declined and cases occur in smaller pockets of well-characterized populations, such as communities of foreign-born persons and socioeconomically disadvantaged groups. New strategies for the treatment of both active and latent tuberculosis may soon include the newly licensed, long-acting rifamycin, rifapentine, but further studies are needed to determine optimal dosing regimens for this agent. Experts in tuberculosis and HIV infection have made headway in defining the optimal therapy for each current therapeutic option, and recently published guidelines are a useful document for clinicians. Rifabutin-based regimens are one approach toward achieving the optimal treatment of both diseases simultaneously. Finally, newly licensed molecular diagnostic tests for direct use on clinical specimens are intriguing, but their clinical utility remains to be defined.     

Comparison of altitude effect on Mycobacterium tuberculosis infection between rural and urban communities in Peru

The mechanism of high altitude effect on tuberculosis (TB) infection has not been fully established. We previously reported a lower positive tuberculin skin test (TST) prevalence in high altitude villages compared with sea level communities in Peru. In this study, four additional communities were tested to assess whether decreased TB transmission was also in urban environments at high altitude. TST results from 3,629 individuals in nine communities were analyzed using generalized estimating equations to account for community clustering. Positive TST prevalence was not significantly different between the urban highland and the urban non-highland communities after adjusting for age, household contacts with a TST-positive person or a TB case, and presence of a Bacillus Calmette-Guérin vaccination scar. The effect of population concentration and increased contact with active TB overwhelmed the protective effect of altitude in urban highlands. Highland cities require the same preventive efforts against TB as non-highland communities.     

Tuberculosis diagnostics and biomarkers: needs, challenges, recent advances, and opportunities

Tuberculosis is unique among the major infectious diseases in that it lacks accurate rapid point-of-care diagnostic tests. Failure to control the spread of tuberculosis is largely due to our inability to detect and treat all infectious cases of pulmonary tuberculosis in a timely fashion, allowing continued Mycobacterium tuberculosis transmission within communities. Currently recommended gold-standard diagnostic tests for tuberculosis are laboratory based, and multiple investigations may be necessary over a period of weeks or months before a diagnosis is made. Several new diagnostic tests have recently become available for detecting active tuberculosis disease, screening for latent M. tuberculosis infection, and identifying drug-resistant strains of M. tuberculosis. However, progress toward a robust point-of-care test has been limited, and novel biomarker discovery remains challenging. In the absence of effective prevention strategies, high rates of early case detection and subsequent cure are required for global tuberculosis control. Early case detection is dependent on test accuracy, accessibility, cost, and complexity, but also depends on the political will and funder investment to deliver optimal, sustainable care to those worst affected by the tuberculosis and human immunodeficiency virus epidemics. This review highlights unanswered questions, challenges, recent advances, unresolved operational and technical issues, needs, and opportunities related to tuberculosis diagnostics.     

Infection control in jails and prisons.

At the end of 2005, approximately 7 million people (or 1 of every 33 American adults) were either in jail, in prison, or on parole. Compared with the general public, newly incarcerated inmates have an increased prevalence of human immunodeficiency virus infection, hepatitis B virus infection, hepatitis C virus infection, syphilis, gonorrhea, chlamydia, and Mycobacterium tuberculosis infection. While incarcerated, inmates are at an increased risk for the acquisition of blood-borne pathogens, sexually transmitted diseases, methicillin-resistant Staphylococcus aureus infection, and infection with airborne organisms, such as M. tuberculosis, influenza virus, and varicella-zoster virus. While incarcerated, inmates interact with hundreds of thousands of correctional employees and millions of annual visitors. Most inmates are eventually released to interact with the general public. Tremendous opportunities exist for infectious diseases specialists and infection-control practitioners to have an impact on the health of correctional employees, the incarcerated, and the communities to which inmates return. This article presents a brief review of some of the most important infection-control challenges and opportunities within the correctional setting.     

Incidence of tuberculosis in a community of Senegalese immigrants in Northern Italy.

SETTING: Tuberculosis is the world's foremost cause of death from a single infectious agent among adults. Although morbidity and mortality rates are highest in low income countries, industrialized countries have also faced a recent resurgence of the tuberculosis epidemic. In Europe and the United States increasing tuberculosis incidence rates are observed, particularly among persons with the human immunodeficiency virus infection and immigrants from highly endemic countries. OBJECTIVE: To measure the incidence of tuberculosis in a retrospective cohort of Senegalese immigrants in a closed community. DESIGN: During 1991, 721 of 794 (91%) community residents were actively screened using the tuberculin skin test and chest X-ray. In 1995 the out-patient clinical charts and the tuberculosis notification registers were reviewed to determine tuberculosis incidence. RESULTS AND CONCLUSION: A total of 328 subjects (45.4% of those screened) was retrospectively followed for a cumulative period of 10 147 months. Ten cases of active tuberculosis were detected. The annual incidence rate for tuberculosis was 11.8/1000, compared to 15.1/ 100 000 in the general population. Tuberculosis incidence was similar in subjects with a positive (12.3/1000), compared to a negative baseline tuberculin test (12.5/1000). Tuberculosis incidence is very high, and recent infections might account for a substantial proportion of cases among immigrants living in closed communities.     

不同国家γ干扰素释放试验临床应用指南的概述

γ干扰素释放试验(interferon gamma release assays,IGRAs)是一种新型的快速诊断结核分枝杆菌感染的免疫学方法.目前已经有16个国家制定了IGRAs诊断结核分枝杆菌感染的应用指南.各国IGRAs应用指南主要针对以下情况进行制定的:成人活动性结核病、成人潜伏结核感染、医疗工作者潜伏结核感染...     

Demonstration of reinfection and reactivation in HIV-negative autopsied cases of secondary tuberculosis: multilesional genotyping of Mycobacterium tuberculosis utilizing IS 6110 and other repetitive element-based DNA fingerprinting

SETTING: Secondary tuberculosis may follow reinfection or endogenous reactivation. The design of effective preventive and treatment protocols requires knowledge about the relative importance of these mechanisms in specific communities. Molecular typing of Mycobacterium tuberculosis has permitted linkage of cases and demonstration of patterns of inter- or intrapatient strain diversity correlating with reinfection and reactivation. OBJECTIVE: The use of DNA fingerprinting to examine intrapatient strain diversity in autopsied, HIV-negative individuals resident in a high incidence community. DESIGN: Autopsy (12 cases) and pneumonectomy (one case) permitted multilesional sampling for bacterial culture and comparative genotyping. Mycobacterium tuberculosis strains were typed using probes directed against IS 6110, the direct repeat sequence (DR) and MTB484(1). RESULTS: In two patients, the demonstration of pulmonary infection by two distinct strains suggested dual infection of these individuals. In one other case, the strain isolated from a Ghon-focus was identical to that obtained from all secondary cavitating lesions, which suggested reactivation of the primary infection. In the remaining cases, all isolates were identical, but primary lesions could not be identified with certainty or were culture negative. One of these cases showed evidence of strain evolution. CONCLUSIONS: Multilesional strain genotyping suggested both reinfection and reactivation in a series of HIV-negative autopsied patients with secondary tuberculosis. In most (11/13) cases, the same strain (or clonal variant) was present in all lesions, pulmonary and extrapulmonary.