WHO：结核之战，攻势欠佳
WHO: Progress in fighting TB slowsLONDON -- The fight against the global tuberculosis epidemic has slowed to a crawl, the World Health Organization said in a report Monday. The worldwide rate of TB infection has been declining for several years. But between 2005 and 2006, the rate of new cases fell by less than 1 percent, far less than the annual decrease of 5 to 7 percent sought by health officials.
At the same time, drug-resistant TB is growing faster than ever, the WHO said last month.
Independent health experts criticized the WHO's TB policy as too passive, and urged a more proactive strategy.
WHO conceded the most recent decline in the overall infection rate \"is very modest, and is not as fast as we would like it to be,\" said Dr. Marcos Espinal, executive secretary of the organization's Stop TB Partnership.
\"Without new tools, we will not be able to break the back of this epidemic,\" he said, citing a lack of vaccines, outdated drugs, obsolete diagnostic tests and overwhelmed health systems as contributing to the slowdown against TB.
In 2006, there were an estimated 9.2 million new tuberculosis cases and 1.5 million deaths, the WHO said in its report, which was based on government data from 202 countries and regions.
India and China have the most cases, followed by Indonesia, South Africa and Nigeria, the report said.
By region, Asia has 55 percent of all TB cases, and Africa has 31 percent.
WHO acknowledged its treatment programs \"have not yet had a major impact on TB transmission and incidence,\" according to the report, which assessed the WHO's efforts for the past 12 years.
WHO primarily works by recommending how governments and donors can best fight TB, and it is up to individual countries to decide how to spend funds. Last year, countries and donors spent about $2.3 billion on TB control. This year, WHO estimates that $3.1 billion will be needed to identify and treat TB patients.
The report said TB infection rates were stable in Europe, and declined about 3 percent in the United States.
In Africa, however, they were still increasing as the AIDS epidemic fuels transmission. TB in Africa has increased at least fivefold since the 1990s.
The report said 30 million people - or 84.7 percent of identified TB patients - have been cured through treatment.
Espinal acknowledged that WHO may not have enough evidence to show that its treatment strategy reduces transmission. The strategy works to cure people, he said, not necessarily to reduce the disease's spread.
Other experts countered that if treatment rates were as high as WHO claimed, there would be less drug-resistant tuberculosis.
Last month, WHO said drug-resistant TB was spreading faster than ever. Globally, there are about 500,000 new cases of drug-resistant TB every year, about 5 percent of the 9 million new TB cases, WHO said.
Independent experts also criticized the WHO's reporting, saying it did not take into account those who are infected but not diagnosed, and was gathered from governments without being verified independently.
\"This is a compilation of what the countries want to show,\" said Dr. Francis Varaine, coordinator of Medecins Sans Frontieres' tuberculosis working group. \"Some of these data are too good to be true.\"
In developing countries, WHO's main tuberculosis treatment program depends on patients volunteering to be tested, instead of doctors seeking out patients.
WHO's Espinal estimated that only about 60 percent of infected patients are diagnosed.
\"By the time a TB patient turns up, they have been coughing for weeks and have probably infected most of their family, friends, work mates and anyone else they were in contact with,\" said Ruth McNerney, a TB expert at London's School of Hygiene and Tropical Medicine. She said WHO's strategy was \"like shutting the door after the horse has bolted.\"
http://seattlepi.nwsource.com/health/1500ap_who_tb_report.html
伦敦---世界卫生组织在周一的一份报告中指出：针对全球流行性结核病的战役进展非常缓慢。虽然，全球结核病的感染率这几年来一直呈下降趋势。但2005年和2006年，全球新增结核患者仅下降不到1%，与官方卫生组织期待的年下降率5-7%有很大差距。
与此同时，耐药型结核病正以比以往任何时候都快的速度增长；世界卫生组织上个月公布说。
非官方的健康专家们批评世界卫生组织关于控制结核病的政策过于消极，敦促其采用更积极的策略。
来自世界卫生组织，消除结核病协会的执行秘书，Marcos Espinal 博士说“世卫组织承认最近全球新增结核感染的下降率是非常低，是没有达到我们的预期目标”。
“如果没有新的方法，我们很难完成这一艰巨的任务，”他说，并列举了诸如疫苗的缺乏，药品的过期，落后的诊断方法以及脆弱的卫生体系等导致新增结核感染下降率的低下的原因。
据WHO报道，2006年，根据202个国家和地区官方统计的数据表明，全球当年新增结核患者9，200，000例，结核导致1，500，000人死亡。
报道指出：印度和中国的情况最为严重，紧接着是印度尼西亚，南非和尼日利亚。
从区域上看，55%的病例发生在亚洲，非洲则占了31%。
在一份评估WHO 12年来在控制结核方面取得的成效的报告中，WHO承认其针对结核的治疗计划尚未对结核的传播和发生起到很大作用。
WHO针对结核的工作主要是说服政府以及捐赠人他们能够为抗击结核做些什么（说白了，就是募捐），但是往往等钱到位后，钱怎样花是每个国家自己说了算。去年，政府和慈善机构为控制结核花费了23亿美元。今年，WHO估计，用来确诊和治疗结核病人的费用将达到31亿美元。
报道称，在欧洲，结核感染率已经趋于稳定，在美国，结合感染率下降了大约3%。
但是，在非洲，由于爱滋病可以助长结核传播的原因，结核感染率一直在上升，从19世纪90年代以来，结核感染率至少增加了5倍以上。
报道称，3000万确诊的结核患者（占总确诊患者的84.7%）通过治疗已经痊愈。
Espinal承认WHO没有足够的证据可以证明他们采取治疗的方法能够降低结核的传播。他说，采取治疗结核的策略是可以治愈结核病人，但是不一定能够减少结核的传播。
其他专家则认为，如果结核治愈率像WHO公布的那么高的话，那么现在也就不会有这么多耐药型结核了。
上个月，WHO宣布耐药型结核病以前所未有的速度在传播。全球每年有大约50万新发耐药型结核患者，占总共900万新发结核患者的5%左右。
非官方的专家们也质疑WHO的报道，强调该报道没有考虑那些没有被查出的结核感染者，而且该报道的数据都来自政府的官方报道，没有经过独立核对。
“这些都是那些国家编撰的对于他们有利的数据”Medecins Sans Frontieres结核协会协调人Francis Varaine博士说，“这其中的一些数据太完美了让人无法相信”
在发展中国家，WHO的主要结核治疗项目要求病人主动来接受检查，而不是要求医生主动去寻找病人。
WHO的Espinal估计大概仅仅只有60%的被感染者接受了诊断。
“当某个结核患者出现时，他已经咳嗽长达好几个星期了而且很有可能已经把结核传染给了他的大部分家人，朋友，同事以及任何和他有接触的人”来自伦敦大学卫生保健和热带病学院的结核病专家Ruth McNerney说，她评论WHO控制结核的策略就好比亡羊补牢，于事无补。
报道指出：印度和中国的情况最为严重，
页:
[1]