中国结核感染现状（英文版）.ppt

TB: A leading infectious killer- top 3 infectious killer TB kills about 2 million people each year 8 million people become sick with TB each year TB is the leading killer of HIV/AIDS patients 50 million people infected with drug-resistant TB The New Tuberculosis HIV and Drug-resistant TB – A lethal combination and a major threat to TB control WHO declared TB a global emergency in 1993 TB Chemotherapy: THE Effective TB Control Pre-antibiotic era: before 1940s (e.g., cod liver oils, bed rest, fresh air) Drugs used to treat TB: Streptomycin first TB drug (1944), followed by PAS (1946), isoniazid (1952), pyrazinamide (1952), rifampin (1963) (a) Front-line Drugs: isoniazid (INH) rifampicin (RMP), pyrazinamide (PZA), streptomycin, ethambutol. (b) Second-line Drugs: PAS, kanamycin, cycloserine, ethionamide, thiacetazone, ciprofloxacin/ofloxacin, rifapentine, amikacin, viomycin, capreomycin. DOTS-The Best TB Therapysince 1991 DOTS: 6 month therapy - The best therapy against TB (78%-96% cure rate). Initial phase (daily, 2 months) with 4 drugs: INH, RMP, PZA, Ethambutol. Continuation phase (3 times a week, 4 months) with 2 drugs: INH and RMP. DOTS-Plus DOTS + second-line TB drugs (PAS, ethionamide, cycloserine, kanamycin, amikacin etc.) Too expensive (TB case: $11 to $100, cost of treating an MDR-TB case: $150,000) MDR-TB requires extensive chemotherapy (also more toxic to patients- side effects) for up to two years?? DOTS-Plus works as a supplement to the DOTS, to address both drug-susceptible and MDR-TB in areas with significant MDR-TB. Disease Burden of Tuberculosis in China, 2000 data Prevalence of active pulmonary diseases is 367／100,000 Prevalence of Sear positive pulmonary diseases is 122／100,000 130,000 patients die from tuberculosis every year No data of latent tuberculosis in China up to now Factors contribute to tuberculosis reemerging in China MDR TB? HIV increasing? Latent infection? Diagnosis tools are more accurate to find more new cas