Aiming for zero tuberculosis transmission in low-burden countries
2017; Elsevier BV; Volume: 5; Issue: 11 Linguagem: Inglês
10.1016/s2213-2600(17)30382-x
ISSN2213-2619
AutoresBen J. Marais, Timothy M. Walker, Daniela María Cirillo, Mario Raviǵlione, Ibrahim Abubakar, Marieke J. van der Werf, Catharina Boehme, Stefan Niemann, Kenneth G. Castro, Alimuddin Zumla, Vitali Sintchenko, Derrick W. Crook,
Tópico(s)Pneumonia and Respiratory Infections
ResumoThe End TB Strategy, approved by the World Health Assembly in May 2014, proposes ambitious targets to reduce the global burden of tuberculosis (TB). 1 WHOEnd TB Strategy. 2014http://www.who.int/tb/End_TB_brochure.pdf Google Scholar The strategy calls for all governments to show high-level political commitment, including those of high-income countries with a low burden of disease. The framework for TB elimination in low-incidence countries, launched at the World TB Conference in 2015, challenged low-burden countries to aim for TB elimination (defined as <1 incident case of TB per million population) by 2035 or earlier. 2 Lönnroth K Migliori GB Abubakar I et al. Towards tuberculosis elimination: an action framework for low-incidence countries. Eur Resp J. 2015; 45: 928-952 Crossref PubMed Scopus (548) Google Scholar In low-incidence settings, most cases of TB occur among foreign-born individuals; thus, to achieve a substantial reduction in case numbers, meticulous premigration screening and an emphasis on the identification of active cases among often hard-to-reach populations, with treatment of both active and latent TB infection, is necessary. 3 Rangaka MX Cavalcante SC Marais BJ et al. Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infection. Lancet. 2015; 386: 2344-2353 Summary Full Text Full Text PDF PubMed Scopus (134) Google Scholar Consideration will need to be given to risk–benefit analyses and the cost-effectiveness of these approaches, which might not always be feasible or ethically acceptable. Measuring tuberculosis transmission in low-incidence countriesIn The Lancet Respiratory Medicine, Ben J Marais and colleagues1 discussed the application of whole genome sequencing (WGS) to tuberculosis control and, more specifically, its utility in quantifying transmission in low-incidence countries. We fully agree that advances in diagnostic microbiology, and WGS in particular, are highly promising in this respect. Probably in the very near future, WGS will be used in low-incidence countries to replace phenotypic drug susceptibility testing (DST) for Mycobacterium tuberculosis isolates lacking encoding mutations in the 23 resistance genes. Full-Text PDF
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