世界卫生组织西太平洋区域耐药结核病

(1)

a Ϫ⬠ि⫳㒘㒛㽓໾ᑇ⋟ऎඳࡲџ໘Ӵᶧ⮙᥻ࠊৌ䘣ࠊ㒧Ḍ⮙੠⍜䰸咏亢⮙໘ˈ㧆ᕟᆒ偀ሐᢝǄ ᡩ〓᮹ᳳ˖2014ᑈ11᳜21᮹˗থ㸼᮹ᳳ˖2014ᑈ12᳜18᮹

doi: 10.5365/wpsar.2014.5.4.007

ܼ

^{⧗↣ᑈ㑺᳝}⅏Ѣ䖭⾡ৃҹ⊏ᛜⱘ⮒⮙

¹⁶⁰

^{ϛҎ㕍ᙷ㒧Ḍ⮙ˈ}^[1]Ǆ㒧Ḍ⮙Џ㽕

¹¹

^ϛҎ

೼ᔅ࢓㕸ԧЁথ⫳ˈ՟བ⿏⇥ǃܓスǃ㗕 ᑈҎ੠かҎǄ

WHO

㽓໾ᑇ⋟ऎඳ೼㒧Ḍ⮙᥻ࠊᮍ䴶প ᕫњᰒ㨫䖯ሩˈ೼Ⳃᷛᑈ

2015

ᑈПࠡህᏆ㒣ᦤࠡᅲ

⦄њ㒧Ḍ⮙᥻ࠊⳌ݇ⱘगᑈথሩⳂᷛҹঞⳌ݇೑䰙Ⳃ

ᷛǄ㒧Ḍ⮙ᙷ⮙⥛੠⅏ѵ⥛ԢѢ

1990

ᑈ∈ᑇⱘϔञˈ

⮙՟থ⦄⥛੠⊏ᛜ⥛㓈ᣕ೼䕗催∈ᑇ^[1]ǄሑㅵᏆপᕫ Ϟ䗄៤㒽ˈԚ⬅Ѣᇍᓖ⚳㚐੠߽⽣ᑇϸ⾡ϔ㒓ᡫ㒧 Ḍ㥃⠽㗤㥃ⱘ㒧Ḍᴚ㦠

Mycobacterium tuberculosis

᠔ᓩ䍋ⱘ㗤໮㥃㒧Ḍ⮙

multidrug-resistant TB

ˈㅔ⿄

MDR-TB

Ў㒧Ḍ⮙᥻ࠊᏺᴹњϹዏᣥ៬Ǆ

MDR-TB

⮙՟

᮶ࣙᣀ಴⊏⭫ϡᔧ㗠ѻ⫳㗤㥃ⱘ᮶ᕔ᥹ফ䖛㒧Ḍ⮙⊏

⭫ⱘ⮙՟㒻থᗻ㗤㥃ˈгࣙᣀᛳᶧ㗤㥃㒧Ḍ㦠ⱘᮄ থ⮙՟ॳথᗻ㗤㥃Ǆ

2013

ᑈܼ⧗᡹ਞⱘ㚎㒧Ḍ⮙՟

ЁˈԄ䅵㑺

30

ϛҎ㣗ೈ˖

23

ϛ

-38

ϛЎ

MDR-TB

^[1]Ǆ

݊Ё㑺

1/4

ⱘ⮙՟থ⫳೼

WHO

㽓໾ᑇ⋟ऎඳ೑ᆊǄᅲ 䰙Ϟˈ䆹ऎඳ↣ᑈԄ䅵ᮄ๲

71 000

՟

MDR-TB

⮙՟^[1]Ǆ

໮᭄

94%

ҹϞ

MDR-TB

⮙՟ߚᏗѢЁ೑ǃ㧆ᕟᆒ੠䍞 फϝϾ೑ᆊǄ

0'57%ᰃ݀݅ि⫳乚ඳⱘϔ໻ᣥ៬Ǆ಴Ў݊⊏⭫

਼ᳳ䭓䖒ᑈˈ⊏⭫䖛⿟໡ᴖˈѠ㒓㥃⠽᳝Ϲ䞡ⱘࡃ԰

⫼^[2,3]ˈ⊏⭫䌍⫼催ᯖˈࡴ䞡ᙷ㗙ⱘ㒣⌢䋳ᢙ^[4]ˈ⊏⭫

ᬊᬜ⫮ᖂˈᑊϨ㒭Ҏ࡯䌘⑤㔎У੠ᡔᴃ∈ᑇ᳝䰤ⱘЁ Ԣᬊܹ೑ᆊⱘि⫳ԧ㋏䗴៤Ꮌ໻䋳ᢙ^[5]Ǆ

Ϫ⬠ि⫳㒘㒛㽓໾ᑇ⋟ऎඳ㗤㥃㒧Ḍ⮙

Tauhid Islam

^a

, Tom Hiatt

^a

, Cornelia Hennig

^a

੠ Nobuyuki Nishikiori

^a

䗮䆃԰㗙˖Tauhid Islam (e-mail: islamt@wpro.who.int)Ǆ

㽓 ໾ ᑇ ⋟ ऎ ඳ Ў 㾷 އ 㒧 Ḍ ⮙ 㗤㥃䯂乬 ˈ ೼ ǉ

2011–2015

ᑈ 㽓 ໾ ᑇ ⋟ ऎ ඳ 䘣 ࠊ 㒧 Ḍ ⮙ ऎ ඳ ៬

⬹Ǌ^[6]Ёᇚᠽሩ㗤㥃㒧Ḍ⮙㾘ߦㅵ⧚

programmatic management of drug-resistant TB

ˈㅔ⿄

PMDT

԰ Ў݊Ѩ໻ḌᖗⳂᷛПϔǄᅲ⦄䆹Ⳃᷛ䳔㽕೼ϟ߫৘

ᮍ䴶㦋ᕫ䖯ሩ˖

(1)

䗤ℹ๲ࡴ㒧Ḍ⮙⮙՟ⱘ㥃ᬣ䆩偠

drug susceptibility testing

ˈㅔ⿄

DST

Ẕ⌟⥛ˈ

(2)

⹂ֱ

᠔᳝⹂䆞⮙՟ᕫࠄঞᯊ䞛প᡹ਞᑊ㒇ܹ⊏⭫ˈ

(3)

᠔᳝

᥹ফ⊏⭫ⱘ⮙՟ഛ㛑໳೼᳝ᬜⱘ݇ᗔ῵ᓣϟᅠ៤⊏

⭫ Ǆ

2011

ᑈ ˈ Ў ᐂ ࡽ ৘ ៤ ਬ ೑ ᳝ ᬜ ᠽ ሩ

PMDT

ˈ 㽓໾ᑇ⋟ऎඳ៤ゟњ㓓♃ྨਬӮ

the Western Pacific regional Green Light Committee

Ǆ

ᴀ᭛ᰃ㒻ǉ㽓໾ᑇ⋟ऎඳ㒧Ḍ⮙⌕㸠⮙ᄺ⡍ᕕঞ

݊᥻ࠊ˖2012ᑈ᡹ਞ⮙՟᭄᥂ߚᵤǊ^[7]Пৢⱘ㄀2㆛

㽓໾ᑇ⋟ऎඳ㒧Ḍ⮙᡹ਞǄヨ㗙ಲ乒њWHO㽓໾ᑇ⋟

ऎඳ㒧Ḍ⮙㗤㥃ⱘ᳔ᮄ䖯ሩҹঞ㗤㥃㒧Ḍ⮙㾘ߦᅲᮑ

⦄⢊ǄᇍMDR-TB⮙՟থ⦄ǃ᡹ਞǃ⊏⭫ঞ⭫ᬜㄝ᭄᥂

ⱘߚᵤᇚЎ㾘ߦⱘᬍ䖯੠᳾ᴹᮍ৥ⱘ⹂ᅮᦤկ᳝Ӌؐ

ⱘֵᙃǄ

ᮍ⊩

ᴀ᭛᠔⫼᭄᥂Ў

2007

ᑈ㟇

2013

ᑈ৘៤ਬ೑੠ഄऎ৥

WHO

᡹ਞⱘ᭄᥂Ǆ

2013

ᑈˈ

WHO

㽓໾ᑇ⋟ऎඳ

37

Ͼ

೑ᆊ੠ഄऎЁⱘ

32

Ͼ৥

WHO

᡹ਞњ᭄᥂ˈ㽚Ⲫ㽓໾ᑇ

(2)

ᴃüü

Xpert MTB/RIF

䆩偠㕢೑

Cepheid

ˈࡴ߽⽣ሐѮ Ꮂḥሐ㓈ᇨ^[9]⹂䆞

RR-TB

Ǆ᥼㤤㒣

Xpert MTB/RIF

䆩偠 Ẕ⌟⹂䆞Ў

RR-TB

ⱘ⮙՟ᓔྟ᥹ফᡫ㒧ḌѠ㒓㥃⠽ⱘ⊏

⭫^[10]ˈᑊখ✻

MDR-TB

⮙՟䖯㸠ㅵ⧚Ǆᴀ᭛ᇚ

RR-TB

⮙

՟ᔦЎ

MDR-TB

⹂䆞⮙՟Ǆ

⊏⭫ᬜᵰՓ⫼2011ᑈⱘ᭄᥂ˈ䖭ᰃ᠔㛑㦋পࠄⱘ

᳔ᮄⱘ⊏⭫ᬜᵰ᭄᥂Ǆ

᭄᥂ߚᵤ䞛⫼5㒳䅵ࣙ5Ḍᖗಶ䯳ˈ

2013

ᑈˈ༹

ഄ߽㓈г㒇ˈ

www.R-project.org

ǄЎ⹂ֱⷨおⱘ䗣ᯢ ᗻ੠ৃ䞡໡ᗻ^[11,12]ˈヨ㗙ҹ5NQLWUࣙⱘᮍᓣ݀Ꮧњ⫳

៤ᴀ᭛᭄᥂᠔Փ⫼ⱘ⿟ᑣҷⷕǄ

㒧ᵰ

㗤㥃ⲥ⌟ⱘ㽚Ⲫ㣗ೈ

MDR-TB⮒⮙䋳ᢙⱘԄㅫ䳔㽕Ңᣕ㓁ⱘⲥ⌟៪䇗ᶹЁ

㦋প㗤㥃᭄᥂Ǆ㦋পࠄWHO㽓໾ᑇ⋟ऎඳ36Ͼ೑ᆊ

੠ഄऎЁ25Ͼ೑ᆊ੠ഄऎⱘ㗤㥃᭄᥂೒1ˈ݊Ё

19Ͼᴹ⑤Ѣᐌ㾘ⲥ⌟ˈ6Ͼ᷀ඨᆼǃЁ೑ǃ㩭সǃ偀

⋟ऎඳ

99.9%

ҹϞⱘҎষǄ᭄᥂⎉Ⲫҹϟݙᆍ˖㚎㒧 Ḍ᡹ਞ⮙՟᭄ঞ⊏⭫ᬜᵰˈ䆞ᮁ੠⊏⭫᳡ࡵˈ㥃⠽ㅵ

⧚ˈ㗤㥃ⲥ⌟੠䇗ᶹˈ

TB/HIV

ঠ䞡ᛳᶧˈᛳᶧ᥻ࠊˈ एࡵҎਬখϢˈ㒧Ḍ⮙᥻ࠊ㒣䌍乘ㅫ੠ᬃߎǄ

⫼ѢԄ䅵৘೑㗤㥃㒧Ḍ⮙䋳ᢙⱘ᭄᥂ᴹ㞾ܼ⧗TB

᭄᥂ᑧǄ⫼ᐌ㾘ⲥ⌟៪㗤㥃䇗ᶹЁ᠔㦋ᕫⱘᙷMDR-TB ⱘ㒧Ḍ⮙ᮄথ⮙՟੠໡⊏⮙՟ⱘ↨՟Ԅㅫ㗤㥃㒧Ḍ⮙

ⱘ⮙՟ᘏ᭄Ǆ䆹ᮍ⊩ⱘ݋ԧᦣ䗄䆺㾕2014ᑈܼ⧗㒧 Ḍ⮙᡹ਞ^[1]ˈ᭄᥂䲚ৃҹҢWHOܼ⧗TB᭄᥂ᑧwww.

who.int/tb/dataЁϟ䕑Ǆ

ᴀ᭛ᦣ䗄њ

2013

ᑈ᳝

MDR-TB

⮙՟᡹ਞⱘ㽓໾

ᑇ⋟ऎඳ೑ᆊ੠ഄऎⱘ㒧Ḍ⮙㗤㥃᭄᥂੠㾘ߦᅲᮑ䖯 ሩǄ߽⫼

1996

ᑈҹᴹ໮⃵䇗ᶹ੠ⲥ⌟ⱘ᭄᥂ˈ䆘Ԅ৘

Ͼ೑ᆊ੠ഄऎⱘ

MDR-TB

থ⮙䍟࢓Ǆ⡍߿݇⊼㒧Ḍ⮙䋳 ᢙ䕗䞡ⱘ᷀ඨᆼǃЁ೑ǃ㗕ᣱǃ㩭সǃᏈᏗѮᮄ޴ݙ Ѯǃ㧆ᕟᆒǃ䍞फ䖭Ͼ೑ᆊⱘᚙމǄ

2 0 1 3

ᑈ ˈ

W H O

乕 Ꮧ њ ׂ 䅶 ৢ ⱘ 㒧 Ḍ ⮙ ⮙

՟ ᅮ Н ˈ ᮄ ๲ њ ߽ ⽣ ᑇ 㗤㥃㒧 Ḍ ⮙

RR-TB

ⱘ ὖ ᗉ^[8]Ǆ2010ᑈˈWHOᡍޚՓ⫼ϔ⾡ᮄⱘᖿ䗳Ẕ⌟ᡔ

೒1. 1997–2014ᑈWHO㽓໾ᑇ⋟ऎඳ৘೑᳝㒧Ḍ⮙㗤㥃᭄᥂ⱘᑈӑ

1997–2004ᑈ 2005–2009ᑈ 2010–2013ᑈ 2014ᑈ䇗ᶹ䖯㸠Ё ᮴䖥ᑈ᭄᥂

ϡ䗖⫼

᳔᳝ᮄ㗤㥃᭄᥂ⱘᑈӑ

ܡ䋷ໄᯢ˖೒Ёഄඳߦߚ ঞᷛ䆚ϡҷ㸼WHOᇍӏ ԩ೑ᆊǃഄऎǃජᏖǃ乚

ഄ៪䖍⬠ԡ㕂ⱘᗕᑺǄⱑ 㒓ҷ㸼໻㟈䖍๗ˈৃ㛑ᄬ

೼ϔᅮѝ䆂Ǆ

(3)

⮙ ՟ ⱘ ↨ ՟ ᳔ 催 ˈ Ў

6% 95%CI˖ 5–7% Ǆ ໡ ⊏

⮙ ՟ Ё

MDR-TB⮙ ՟ ⱘ ↨ ՟ Ў0-34%Ǆ 㩭 স ໡ ⊏ ⮙

՟ Ё

MDR-TB⮙ ՟ ⱘ ↨ ՟ ᳔ 催 ˈ Ў 34% 95%CI˖

29–38%Ǆ໡⊏⮙՟ЁMDR-TB⮙՟↨՟䍙䖛20%ⱘ

೑ᆊ᳝Ё೑26%ǃ㩭স34%ǃ㧆ᕟᆒ21%੠䍞 फ23%Ǆሑㅵ໡⊏⮙՟Ё MDR-TB⮙՟ⱘ↨՟䕗催ˈ Ԛᮄথ⮙՟ЁMDR-TB⮙՟ⱘ㒱ᇍ᭄䕗催Ǆ

ᮄ থ ⮙ ՟ Ё

MDR-TB

⮙ ՟ ⱘ ↨ ՟ Ϣ ໡ ⊏ ⮙ ՟ Ё

MDR-TB

⮙՟ⱘ↨՟ᄬ೼ℷⳌ݇៾䎱Ў

0.08%

ˈಲᔦ

㋏᭄Ў

3.1%

ˈ

F

ؐЎ

3.84

ˈ

P=0.123

˗೒

2

ˈԚ᮴㒳䅵ᄺᛣНǄ䰸њ㩭স੠㧆ᕟᆒˈ໮᭄೑ᆊ੠ഄऎ໘Ѣ 㒓ᗻಲᔦ㒓ⱘ

95%

ৃֵऎ䯈ҹݙǄ㩭স੠㧆ᕟᆒ໡⊏

⮙՟Ё

MDR-TB

⮙՟ⱘ↨՟催Ѣᮄথ⮙՟Ǆ▇໻߽Ѯǃ 佭␃ǃᮄࡴവ໡⊏⮙՟Ё

MDR-TB

⮙՟ⱘ↨՟ԢѢᮄথ

⮙՟Ǆ

Ԅ䅵

MDR-TB

⮒⮙䋳ᢙ䍟࢓

25Ͼ᳝㥃ᬣ᭄᥂ⱘ೑ᆊЁˈ22Ͼ݋᳝䗮䖛ᣕ㓁ⲥ⌟

៪䞡໡䇗ᶹ᠔㦋ᕫⱘ໮ᯊ⚍᭄᥂Ǆᇍ↨㽓໾ᑇ⋟ऎඳ ᴹ㽓Ѯǃ㧆ᕟᆒ੠䍞फᴹ⑤Ѣ᳝ҷ㸼ᗻ⮙՟ḋᴀⱘᅮ

ᳳ䇗ᶹǄ

Ͼ㒧Ḍ⮙催থ೑ᆊЁ㦋পࠄ5Ͼ೑ᆊ᷀ඨᆼǃ Ё ೑ ǃ 㩭 স ǃ 㧆 ᕟ ᆒ ੠ 䍞 फ ⱘ ೑ ᆊ 㗤㥃 ᢑ ḋ 䇗 ᶹ drug resistance surveyˈㅔ⿄ DRS᭄᥂Ǆ݊Ёˈ᷀

ඨᆼǃ㩭সǃ㧆ᕟᆒ੠䍞फ᳝㟇ᇥϸ⃵೑ᆊ㗤㥃ᢑ ḋ䇗ᶹ᭄᥂ˈЁ೑ℷ೼ᓔሩ㄀Ѡ⃵೑ᆊDRSǄ偀ᴹ㽓 Ѯ1997ᑈⱘ᭄᥂ᴹ⑤Ѣϡ㛑ҷ㸼ᭈϾ೑ᆊⱘ䚼ߚഄ

ऎǄᏈᏗѮᮄ޴ݙѮ੠㗕ᣱ᳝ᕜདⱘDRS᭄᥂ǄᏈᏗ Ѯᮄ޴ݙѮℷ೼ᓔሩഄऎ㑻DRSˈ2015ᑈᇚᕫࠄ䇗ᶹ 㒧ᵰǄ

MDR-TB

⮒⮙䋳ᢙԄ䅵˖⮙՟᭄੠⥛

᥂Ԅ䅵ˈ

2013

ᑈ㽓໾ᑇ⋟ऎඳ

4% 95%CI

˖

3–6%

ⱘ㒧Ḍ⮙ᮄথ⮙՟੠

22% 95%CI

˖

18–26%

ⱘ໡⊏⮙

՟ᄬ೼໮䞡㗤㥃Ǆ

2013

ᑈ㽓໾ᑇ⋟ऎඳ㑺᳝

71 000

՟

MDR-TB

⮙՟ˈ݊Ё

53 000

՟

75%

Ўᮄথ⮙՟ˈ

18 000

՟

25%

Ў໡⊏⮙՟㸼

1

Ǆᮄথ⮙՟Ё

MDR- TB

⮙ ՟ ⱘ ↨ ՟ Ў

0-6%

Ǆ Ё ೑ ᮄ থ ⮙ ՟ Ё

MDR-TB

㸼 1. 㽓໾ᑇ⋟ऎඳ䚼ߚ೑ᆊ *MDR-TB Ԅ䅵⮙՟᭄ঞᮄথ੠໡⊏⮙՟Ё MDR-TB ⮙՟ⱘ↨՟

೑ᆊ੠ഄऎ ᭄᥂㉏ൟ ᑈӑ ᮄথ⮙՟ЁⱘMDR-TB⮙՟ ໡⊏⮙՟ЁⱘMDR-TB⮙՟ MDR-TB⮙՟᭄ড়䅵

Ҏ᭄ (95% CI) % Ҏ᭄ (95% CI) % Ҏ᭄ (95% CI)

▇໻߽Ѯ ⲥ⌟᭄᥂ 2013 16 (9–27) 2 (1–4) 1 (0–7) 4 (<1–21) 17 (8–26)

᭛㦅 ⲥ⌟᭄᥂ 2013 1 (0–6) <1 (<1–4) 0 (0–3) 0 (0–46) 1 (0–3)

᷀ඨᆼ 䇗ᶹ᭄᥂ 2007 320 (160–580) 1 (<1–3) 180 (68–370) 11 (4–22) 510 (270–740)

Ё೑ 䇗ᶹ᭄᥂ 2007 45 000 (35 000–55 000) 6 (5–7) 9200 (7800–11 000) 26 (22–30) 54 000 (48 000–61 000)

佭␃ ⲥ⌟᭄᥂ 2012 34 (21–52) <1 (<1–1) 9 (3–20) 3 (<1–6) 43 (26–59)

▇䮼 ⲥ⌟᭄᥂ 2013 7 (2–16) 2 (<1–5) 4 (1–10) 12 (2–30) 11 (4–18)

ᑧܟ㕸ቯ ⲥ⌟᭄᥂ 2013 0 (0–1) 0 (0–98) 0 (0–0) 0 (0–0) 0 (0–1)

᮹ᴀ ⲥ⌟᭄᥂ 2002 110 (63–160) <1 (<1–1) 100 (72–130) 10 (7–13) 200 (150–260)

㗕ᣱ ῵ൟ^噛 160 (96–230) 5 (3–6) 65 (56–75) 24 (20–27) 220 (160–290)

偀ᴹ㽓Ѯ 䇗ᶹ᭄᥂ 1997 19 (0–120) <1 (0–<1) 0 (0–340) 0 (0–17) 19 (0–57)

偀㒡ᇨ㕸ቯ ⲥ⌟᭄᥂ 2013 2 (0–9) 1 (<1–7) 0 (0–5) 0 (0–71) 2 (0–5) ᮄথ⮙՟˖

䇗ᶹ᭄᥂

2007

㩭স ໡⊏⮙՟˖

ⲥ⌟᭄᥂

2013 33 (16–59) 1 (<1–3) 210 (180–240) 34 (29–38) 240 (210–280)

ᮄ㽓݄ ⲥ⌟᭄᥂ 2012 1 (0–5) <1 (<1–3) 2 (0–5) 17 (2–48) 3 (0–6)

Ꮹࢇ ⲥ⌟᭄᥂ 2013 0 (0–3) 0 (0–41) 0 (0–0) 0 (0–0) 0 (0–3)

ᏈᏗѮᮄ޴ݙѮ ῵ൟ^噛 560 (340–800) 5 (3–6) 570 (480–650) 24 (20–27) 1100 (890–1400)

㧆ᕟᆒ 䇗ᶹ᭄᥂ 2013 4400 (3100–6000) 2 (1–3) 4100 (3000–5500) 21 (16–29) 8500 (6900–10 000)

䶽೑ ⲥ⌟᭄᥂ 2004 780 (600–980) 3 (2–3) 1200 (850–1600) 14 (10–19) 1900 (1600–2300)

ᮄࡴവ ⲥ⌟᭄᥂ 2013 17 (8–30) <1 (<1–2) 3 (0–12) 3 (<1–9) 20 (9–31)

䍞फ 䇗ᶹ᭄᥂ 2012 3000 (1900–4100) 4 (3–5) 2100 (1500–2600) 23 (17–30) 5100 (4100–6100)

㽓໾ᑇ⋟ऎඳ 53 000 (31 000–75 000) 4 (3–6) 18 000 (15 000–21 000) 22 (18–26) 71 000 (47 000–94 000)

᭄᥂ᴹ⑤˖ܼ⧗㒧Ḍ⮙᭄᥂ᑧǄ CIৃֵऎ䯈MDR-TB㗤໮㥃㒧Ḍ⮙Ǆ

2013ᑈ᳝MDR-TB⮙՟᡹ਞⱘ೑ᆊǄ

噛䗮䖛῵ൟ˄ࣙᣀ໮䞡ᦦ㸹˅ˈ߽⫼Ϣᴀ೑㒧Ḍ⮙⌕㸠⮙ᄺ⡍ᕕⳌԐⱘ೑ᆊⱘ᭄᥂ˈԄ䅵MDR-TB⮙՟᭄ঞᮄথ੠໡⊏⮙՟ЁMDR-TB⮙՟ⱘ↨՟Ǆ

(4)

6Ͼ೑ᆊ㒧Ḍ⮙ᮄথ⮙՟থ⮙⥛੠ᮄথ⮙՟ЁMDR-TB

⮙՟↨՟ⱘ䍟࢓ˈথ⦄4⾡῵ᓣ೒3Ǆ㩭স੠䍞फⱘ 㒧Ḍ⮙ᮄথ⮙՟থ⮙⥛੠ᮄথ⮙՟ЁMDR-TB⮙՟↨

՟ഛਜϞछ䍟࢓㩭সᮄথ⮙՟ЁMDR-TB⮙՟↨՟Ң

1999ᑈ㟇2007ᑈᑇഛ↣ᑈϞछ7%ˈ䍞फᮄথ⮙՟Ё MDR-TB⮙՟↨՟Ң1997ᑈ㟇2012ᑈᑇഛ↣ᑈϞछ 4%Ǆ▇໻߽Ѯ੠㧆ᕟᆒⱘ㒧Ḍ⮙ᮄথ⮙՟থ⮙⥛ਜ

Ϟछ䍟࢓ˈԚᮄথ⮙՟ЁMDR-TB⮙՟↨՟ਜϟ䰡䍟

࢓▇໻߽Ѯᮄথ⮙՟ЁMDR-TB⮙՟↨՟Ң

2010ᑈ

㟇

2012ᑈ ᑇ ഛ ↣ ᑈ ϟ 䰡 9%ˈ 㧆 ᕟ ᆒ ᮄ থ ⮙ ՟ Ё MDR-TB⮙՟↨՟Ң2004ᑈ㟇2012ᑈᑇഛ↣ᑈϟ䰡 4%Ǆ佭␃ⱘ㒧Ḍ⮙ᮄথ⮙՟থ⮙⥛੠ᮄথ⮙՟Ё MDR-TB⮙՟↨՟ഛਜϟ䰡䍟࢓ᮄথ⮙՟ЁMDR-TB⮙

՟↨՟Ң1996ᑈ㟇2012ᑈᑇഛ↣ᑈϟ䰡8%Ǆ䶽೑

ⱘ㒧Ḍ⮙ᮄথ⮙՟থ⮙⥛ਜϟ䰡䍟࢓ˈԚᮄথ⮙՟Ё

MDR-TB⮙՟↨՟ਜϞछ䍟࢓ᮄথ⮙՟ЁMDR-TB⮙՟

↨՟Ң1996ᑈ㟇2005ᑈᑇഛ↣ᑈϞछ2%ǄᇍϞ䗄㒧ᵰ䖯㸠㾷䞞ᯊ䳔㽕ᜢ䞡ˈ಴Ўᑊ䴲᠔᳝೑ᆊഛ᳝㛑

໳⹂ߛԧ⦄MDR-TB⮒⮙䋳ᢙ䍟࢓ⱘܙ䎇᭄᥂Ǆ 㥃ᬣ䆩偠

DST

2013

ᑈ᳝

18

Ͼ೑ᆊ᡹ਞњ㥃ᬣ䆩偠᭄᥂Ǆҙ

3%

ⱘ 㒧 Ḍ ⮙ ᮄ থ ⮙ ՟ ੠ ⱘ ໡ ⊏ ⮙ ՟ ᥹ ফ њ

MDR-TB

៪

RR-TB

㥃 ᬣ 䆩偠 Ẕ ⌟

㸼 2

Ǆ ᮄ থ ⮙ ՟

MDR-TB

㥃 ᬣ 䆩偠 Ẕ ⌟ ⥛ Ԣ Ѣ

10%

ⱘ ೑ ᆊ ࣙ ᣀ Ё ೑

3%

ǃ

೒ 2. 2013 ᑈ 㽓 ໾ ᑇ ⋟ ऎ ඳ 䚼 ߚ ೑ ᆊ * ᮄ থ ⮙ ՟ Ё MDR-TB ⮙՟↨՟Ϣ໡⊏⮙՟Ё MDR-TB ⮙՟↨՟

ⱘⳌ݇ᗻ

^噛

MDR-TB㗤໮㥃㒧Ḍ⮙Ǆ

* 2013ᑈ᡹ਞњᮄথ⮙՟੠໡⊏⮙՟ЁMDR-TB⮙՟ⱘ೑ᆊǄ

† Ⳉ㒓Ў㒓ᗻಲᔦ㒓ˈ䰈ᕅ䚼ߚЎ95%ৃֵऎ䯈Ǆ

0.4

0.3

0.2

0.1

0.0

0.00 0.02 0.04 ᮄথ⮙՟ЁMDR-TB⮙՟↨՟

▇໻߽Ѯ ᮄࡴവ 佭␃

᮹ᴀ

᷀ඨᆼ ▇䮼

䶽೑

ᮄ㽓݄

㧆ᕟᆒ 㩭স

䍞फ

Ё೑

໡⊏⮙՟ЁMDR-TB⮙՟↨՟

೒3. 1996–2012ᑈ㽓໾ᑇ⋟ऎඳ䚼ߚ೑ᆊ㒧Ḍ⮙ᮄথ⮙՟থ⮙⥛˄咥㒓˅੠ᮄথ⮙՟ЁMDR-TB⮙՟↨՟

˄㓓㒓˅

MDR-TB㗤໮㥃㒧Ḍ⮙Ǆ

0.01 0.1 1 10 100 1000

1996 1998 2000 2002 2004 2006 2008 2010 2012 0.9% per year

4% per year

▇໻߽Ѯ 佭␃ 㩭স

㧆ᕟᆒ 䶽೑ 䍞फ

থ⮙⥛˄1/10ϛ˅ _0.01

0.1 1 10 100 1000

3% per year

7% per year

0.01 0.1 1 10 100 1000

3% per year

-9% per year 3% per year

-9% per year

↣ᑈ3%

–9%ⱘ䗳ᑺ๲䭓

0.01 0.1 1 10 100 1000

1996 1998 2000 2002 2004 2006 2008 2010 2012 5% per year

-4% per year

↣ᑈ5%

0.01 0.1 1 10 100 1000

1996 1998 2000 2002 2004 2006 2008 2010 2012 -2% per year

-2% per year –2%ⱘ䗳ᑺ๲䭓

–2%ⱘ䗳ᑺ๲䭓 0.01

0.1 1 10 100 1000

-3% per year

-8% per year –8%ⱘ䗳ᑺ๲䭓

↣ᑈ7%

↣ᑈ3%

↣ᑈ0.9%

↣ᑈ4%

(5)

MDR-TB

⮙՟᡹ਞ੠㒇ܹ⊏⭫ᚙމ

2013

ᑈ ˈ 㽓 ໾ ᑇ ⋟ ऎ ඳ ݅ ᡹ ਞ

MDR-TB

⮙ ՟ ੠

RR-TB⮙՟11 153՟ˈऴԄ䅵⮙՟᭄㚎㒧Ḍ⮙՟Ё MDR-TB⮙՟᭄Ԅ䅵Ў71 000՟ⱘ16%Ǆ݊Ё2379՟

Ўᮄথ⮙՟ˈऴԄ䅵⮙՟᭄ᮄথ⮙՟ЁMDR-TB⮙՟

᭄Ԅ䅵Ў53 000՟ⱘ4%Ǆ5664՟Ў໡⊏⮙՟ˈऴԄ 䅵⮙՟᭄໡⊏⮙՟ЁMDR-TB⮙՟᭄Ԅ䅵Ў18 000՟

ⱘ

31%Ǆ 㩭 স ǃ 㧆 ᕟ ᆒ ǃ 䍞 फ ໡ ⊏ ⮙ ՟ Ё ⱘ MDR- TB⮙ ՟ ᭄ ߚ ߿ ऴ Ԅ 䅵 ⮙ ՟ ᭄ ⱘ 84%ǃ 33%ǃ 47%

㸼3Ǆ

2013

ᑈ᡹ਞⱘ

MDR-TB

⮙՟Ёˈҙ

62%(6926/

11 153)

㒇ܹњᡫ㒧ḌѠ㒓㥃⠽ⱘ⊏⭫Ǆ䖥ᑈᴹˈᇸ݊

ᰃ

2011

ᑈҹᴹˈ໮᭄೑ᆊ

MDR-TB

⮙՟⊏⭫⥛ਜ〇ℹ

๲䭓ᗕ࢓ǄԚ೼Ё೑ǃ㧆ᕟᆒ੠䍞फˈ᡹ਞ⮙՟᭄੠

⊏⭫⮙՟᭄П䯈ⱘᏂ䎱ℷ೼ࡴ໻㸼

4

ˈ೒

5

Ǆ 㗕 ᣱ

<1% ǃ 㧆 ᕟ ᆒ <1% ǃ 䶽 ೑ 4% ੠ 䍞 फ

3%ˈ໡⊏⮙՟MDR-TB㥃ᬣ䆩偠Ẕ⌟⥛ԢѢ50%ⱘ

೑ᆊࣙᣀЁ೑20%ǃ᮹ᴀ43%ǃ㗕ᣱ26%ǃ 偀ᴹ㽓Ѯ9%ǃ偀㒡ᇨ㕸ቯ43%ǃ㧆ᕟᆒ14%ǃ

䶽೑9%੠䍞फ45%Ǆ

2013

ᑈ ᠔ Ẕ ⌟ ⱘ ⮙ ՟ Ё ˈ

8%

ҙ ᇍ ᓖ ⚳ 㚐㗤㥃ˈ

2%

ҙᇍ߽⽣ᑇ㗤㥃ˈ

11%

ᇍѠ㗙ഛ㗤㥃᭄᥂᳾

ሩ⼎Ǆ㽓໾ᑇ⋟ऎඳ

17%

㒣

Xpert MTB/RIF

䆩偠Ẕ⌟ⱘ

⮙՟Ў

MDR-TB

⮙՟ˈ䍞फ䆹↨՟᳔催ˈ䖒

81%

ˈᏈᏗ Ѯᮄ޴ݙѮЎ

72%

㸼

2

Ǆ

೼MDR-TB⮒⮙䋳ᢙ䕗催ⱘ೑ᆊˈ໡⊏⮙՟ⱘ㥃 ᬣ䆩偠Ẕ⌟⥛〇ℹᦤ催ˈԚMDR-TB䰇ᗻ⥛ሙ催ϡϟ

೒4Ǆᅲ䰙Ϟˈ䗮ᐌᄬ೼ϔ⾡⶯Ⳓⱘؒ৥ˈ㥃ᬣ䆩偠 Ẕ ⌟ ⥛ 䕗催 ⱘ ೑ ᆊ ᰃ Ẕ ߎ

MDR-TB䰇 ᗻ ↨ ՟ 䕗 Ԣ

ⱘ೑ᆊǄ

㸼2. 2013ᑈ㽓໾ᑇ⋟ऎඳ䚼ߚ೑ᆊ㒧Ḍ⮙ᮄথ⮙՟੠໡⊏⮙՟Ё᳝DSTẔ⌟㒧ᵰⱘ⮙՟᭄੠↨՟ǃMDR-TB⮙

՟੠RR-TB⮙՟᭄੠↨՟ǃXpertẔ⌟⹂䆞ⱘMDR-TB⮙՟੠RR-TB⮙՟᭄੠↨՟

೑ᆊ੠ഄऎ

᳝DSTẔ⌟㒧ᵰⱘ㒧Ḍ⮙⮙՟ ᳝DSTẔ⌟㒧ᵰ㒧Ḍ⮙⮙՟ⱘMDR-TB੠

RR-TB*⮙՟ XpertẔ⌟⹂䆞ⱘMDR-TB⮙՟੠RR-TB⮙՟^噛 ᮄথ⮙՟ ໡⊏⮙՟ ড়䅵 ᮄথ⮙՟ ໡⊏⮙՟ ড়䅵 ᮄথ⮙՟ ໡⊏⮙՟ ড়䅵 Ҏ᭄ % Ҏ᭄ % Ҏ᭄ % Ҏ᭄ % Ҏ᭄ % Ҏ᭄ % Ҏ᭄ % Ҏ᭄ % Ҏ᭄ %

▇໻߽Ѯ 570 82 25 76 604 83 13 2 3 12 17 3 0 – 0 – 0 –

᭛㦅 146 92 6 100 152 93 1 <1 0 – 1 <1 0 – 0 – 0 –

᷀ඨᆼ – – – – – – – – – – – – – – – – – –

Ё೑ 20 080 3 7153 20 27 233 3 1612 8 2571 36 4183 15 244 15 246 10 490 12

佭␃ 1919 55 198 56 2117 55 28 1 7 4 35 2 0 – 0 – 0 –

▇䮼 244 70 26 81 305 80 6 2 3 12 9 3 0 – 0 – 0 – ᑧܟ㕸ቯ 1 100 0 – 1 100 0 0 0 – 0 – 0 – 0 – 0 –

᮹ᴀ 7266 49 435 43 7 42 <1 22 5 64 <1 – – – – – –

㗕ᣱ 11 0 0 7 10 7 9 0 – 0 – 0 –

偀ᴹ㽓Ѯ 2702 14 181 9 11 110 52 80 3 5 3 185 2 0 – 0 – 0 –

偀㒡ᇨ㕸ቯ 72 61 3 43 75 60 1 1 0 0 1 1 0 – 0 – 0 – 㩭স 289 12 531 85 838 28 24 22 177 33 242 29 15 23 38 21 53 22

ᮄ㽓݄ – – – – – – 1 – 1 – 2 – – – – – – –

Ꮹࢇ 7 0 – 0 – 0 – 0 – 0 – 0 –

ᏈᏗѮᮄ޴ݙѮ – – – – 93 <1 – – – – 46 49 – – – – 33 72

㧆ᕟᆒ 25 <1 2631 14 2656 1 10 40 1349 51 1359 51 – – – – – –

䶽೑ 1249 4 726 9 1975 5 466 37 518 71 984 50 – – – – – – ᮄࡴവ 1070 61 85 66 1155 62 14 1 4 5 18 2 0 – 0 – 0 –

䍞फ 353 <1 3955 45 4531 5 40 11 997 25 1041 23 37 92 801 80 841 81

㽓໾ᑇ⋟ऎඳ 36 103 3 16 057 20 60 765 5 2379 7 5664 35 8195 13 296 12 1085 19 1417 17 DST㥃ᬣ䆩偠MDR-TB㗤໮㥃㒧Ḍ⮙Prev໡⊏㒧Ḍ⮙⮙՟RR-TB߽⽣ᑇ㗤㥃㒧Ḍ⮙Ǆ

*2013ᑈ᳝MDR-TB⮙՟᡹ਞⱘ೑ᆊǄ

噛 ࣙᣀ߽⽣ᑇ㗤㥃㒧Ḍ⮙⮙՟ˈ᮴䆎݊ᰃ৺㒣䖛DST៪XpertẔ⌟Ǆ

(6)

㒓㥃⠽ⱘ㥃ᬣ䆩偠㒧ᵰǄ㓐ড়

12

Ͼ೑ᆊⱘ᭄᥂ˈ೼

㒣䖛ᡫ㒧ḌѠ㒓㥃⠽ⱘ㥃ᬣ䆩偠Ẕ⌟ⱘ⮙՟Ёˈ

12%

ⱘ⮙՟ᇍ⇳஍䇎䝂

fluoroquinolones

ˈㅔ⿄

FQ

㗤㥃ˈ

8%

ᇍѠ㒓⊼ᇘࠖ㗤㥃ˈ

13%

ᇍ⇳஍䇎䝂៪Ѡ㒓⊼ᇘࠖ

㗤㥃៪Ѡ㗙ഛ㗤㥃Ǆᑓ⊯㗤㥃㒧Ḍ

Extensively drug- resistant TB

ˈㅔ⿄

XDR-TB

ᣛ

MDR-TB

⮙՟Ёᇍ⇳஍

䇎䝂ҹঞϔ⾡៪໮⾡Ѡ㒓⊼ᇘࠖ㗤㥃Ǆ

2013

ᑈ㽓໾ᑇ

⋟ऎඳ

6

Ͼ೑ᆊ݅᡹ਞ

107

՟

XDR-TB

⮙՟ऴ㽓໾ᑇ⋟

ऎඳ೑ᆊ੠ഄऎ

XDR-TB

⮙՟ⱘ

17%

ˈऴ

MDR-TB

⮙՟

ⱘ

5%

Ǆ䶽೑

XDR-TB

⮙՟ⱘ↨՟᳔催ˈऴ

MDR-TB

⮙՟

ⱘ

10%

Ǆ

MDR-TB

ㅵ⧚䌍⫼

䖥ᑈᴹ

MDR-TB

ㅵ⧚䌍⫼ᰒ㨫๲ࡴ೒

7

Ǆ

2013

ᑈ㽓໾

ᑇ⋟ऎඳ

MDR-TB

ㅵ⧚䌍⫼݅䅵

5730

ϛ㕢ܗˈऴ೑ᆊ 㒧Ḍ⮙乍Ⳃ㒣䌍ᘏ᭄ⱘ

10.9%

Ǆ

18.4%

ⱘ㒣䌍ᴹ㞾೑

ݙᬓᑰᢼℒˈ݊ԭ

81.6%

ⱘ㒣䌍ᴹ㞾໪䚼䌘ࡽǄѠ㒓㥃⠽䌍⫼ऴ

MDR-TB

ㅵ⧚ᘏ䌍⫼ⱘ

27.8%

Ǆ

MDR-TB

⊏⭫ᬜᵰ

15Ͼ೑ᆊ᡹ਞњ 2011ᑈ⊏⭫䯳߫ⱘ᭄᥂ǄMDR-TB

⮙՟Ёˈ52%៤ࡳᅠ៤њ⊏⭫ˈ21%༅䆓ˈ10%⅏ѵ

೒6Ǆ▇䮼ⱘ⊏⭫៤ࡳ⥛Ў100%ˈᏈᏗѮᮄ޴ݙѮ ҙЎ14%Ǆ

Ё೑

2007

ᑈ㟇

2011

ᑈⱘ⊏⭫៤ࡳ⥛ԢѢ

50%

ˈ

⅏ѵ⥛੠༅䋹⥛ሙ催ϡϟǄ偀ᴹ㽓Ѯ੠㧆ᕟᆒⱘ⊏⭫

៤ࡳ⥛ᣕ㓁ϟ䰡ˈ偀ᴹ㽓ѮⱘЏ㽕ॳ಴ᰃ㔎У⮙՟䆘 Ԅˈ㧆ᕟᆒⱘЏ㽕ॳ಴ᰃ⮙՟༅䆓Ǆ೼㒧Ḍ⮙⮒⮙䋳 ᢙ䕗催ⱘ೑ᆊЁˈ᷀ඨᆼ

86%

੠䍞फ

72% 2011

ᑈ 䯳߫ⱘ⊏⭫៤ࡳ⥛䕗催Ǆ

ᡫ㒧ḌѠ㒓㥃⠽㥃ᬣ䆩偠ঞᑓ⊯㗤㥃㒧Ḍ

XDR-TB

2013

ᑈ

12

Ͼ೑ᆊ᡹ਞњᡫ㒧ḌѠ㒓㥃⠽ⱘ㥃ᬣ䆩偠

᭄᥂Ǆ㒇ܹ⊏⭫ⱘ

MDR-TB

⮙՟Ёˈ

34%

᳝ᡫ㒧ḌѠ

೒ 4. 2007–2013 ᑈ WHO 㽓໾ᑇ⋟ऎඳ໡⊏⮙՟'67Ẕ⌟⥛ҹঞ MDR-TB ੠ RR-TB ⮙՟䰇ᗻ⥛ᯊ䯈ߚᏗ

DST㥃ᬣ䆩偠˗MDR-TB㗤໮㥃㒧Ḍ⮙˗RR-TB߽⽣ᑇ㗤㥃㒧Ḍ⮙Ǆ

ⱒߚ↨

0 20 40 60 80

0 2 4 6 8 10 12

0 50 100 150 200

0 20 40 60 80 100

0 20 40 60 80

2007 2009 2011 2013

0 20 40 60 80

2007 2009 2011 2013

0 20 40 60 80

2007 2009 2011 2013

0 20 40 60 80

2007 2009 2011 2013

▇໻߽Ѯ Ё೑ 佭␃ ᮹ᴀ

偀ᴹ㽓Ѯ 㩭স 㧆ᕟᆒ 䶽೑

ᮄࡴവ 䍞फ 㽓໾ᑇ⋟ऎඳ

໡⊏⮙՟DSTẔ⌟

⥛˄%˅ Ẕ⌟⮙՟ЁMDR-

TB੠RR-TB⮙՟

䰇ᗻ⥛˄%˅

(7)

࡯䌘⑤೼㚎㒧Ḍ⮙՟Ёথ⦄

MDR-TB

⮙՟ⱘ᳝ᬜㄪ⬹䴲 ᐌೄ䲒ǄЎњ⹂ᅮ┰೼ⱘ催亢䰽Ҏ㕸ҹ᳝֓䗝ᢽᗻⱘ ᓔሩ'67Ẕ⌟ˈ䳔㽕ᠽ໻੠ࡴᔎⲥ⌟㋏㒳Ǆ

XDR-TBг᮹Ⲟফࠄ݇⊼ǄⳂࠡ12Ͼ೑ᆊⱘᡫ㒧

ḌѠ㒓㥃⠽'67Ẕ⌟⥛ҙЎ34%ˈXDR-TB⮒⮙䋳ᢙⱘ ⳳℷ㾘῵ᇮϡ⏙ἮǄ䱣ⴔPMDTⱘᠽሩҹঞᡫ㒧ḌѠ㒓㥃⠽DSTẔ⌟㛑࡯ⱘᦤ催ˈᇚӮ䆞ᮁߎ᳈໮ⱘXDR-TB

⮙՟Ǆ㒧Ḍ⮙乍Ⳃ䳔㽕خདᑨᇍXDR-TBⱘޚ໛ˈᣝ✻

XDR-TB⮙՟ㅵ⧚ᣛफࠊᅮࣙᣀ䗖ᔧⱘྥᙃ⊏⭫੠ᛳᶧ

᥻ࠊᬓㄪ೼ݙⱘᮍḜǄ

MDR-TB⮙՟⹂䆞ৢᑨሑᖿ᥹ফ⊏⭫ˈ䖭ϔ⚍г

㟇݇䞡㽕Ǆ⹂䆞 MDR-TB⮙՟䕗Ўೄ䲒ˈ䳔㽕Ҭߎᕜ

໮ࡾ࡯ǄབᵰMDR-TB⮙՟⹂䆞ৢϡ㛑᥹ফ⊏⭫ˈ䙷 ᠔Ҭߎⱘࡾ࡯ህⱑ䌍њǄҸҎ䳛᚞ⱘᰃˈ2013ᑈ㽓໾

ᑇ⋟ऎඳ᳝38%ⱘ᡹ਞ⮙՟᳾᥹ফ⊏⭫48%ⱘЁ೑

⮙՟ˈ43%ⱘ㧆ᕟᆒ⮙՟ˈ21%ⱘ䍞फ⮙՟Ǆ᡹ਞ 㒭WHO㽓໾ᑇ⋟ऎඳࡲџ໘ⱘ⮙՟᳾⊏⭫ॳ಴ᕜ໮ˈ

ࣙᣀ⬅Ѣ⊏⭫㛑࡯᳝䰤ࣙᣀ㥃⠽ǃԣ䰶ǃ⊏⭫ᬃᣕ

䅼䆎

㽓໾ᑇ⋟ऎඳᢹ᳝

MDR-TB

⮒⮙䋳ᢙ䕗催ⱘ೑ᆊˈ՟བ Ё೑ǃ㧆ᕟᆒǃ䍞फˈҹঞϔѯ⮙՟᭄䕗ᇥⱘ໾ᑇ⋟

ቯ೑Ǆ৘៤ਬ೑ⱘ

PMDT

ᠻ㸠г໘Ѣϡৠ䰊↉Ǆ ᠽሩ

PMDT

ⱘ㄀ϔℹህᰃࡴᔎ䆞ᮁ㛑࡯ˈᦤ催㒧 Ḍ⮙⮙՟᥹ফ

DST

Ẕ⌟ⱘ↨՟Ǆ䘣ࠊ㒧Ḍ⮙ܼ⧗䅵ߦ 䆒ᅮњ

DST

ⱘⳌ݇Ⳃᷛˈ㽕∖ࠄ

2015

ᑈ໡⊏⮙՟

DST

Ẕ⌟⥛䖒ࠄ

100%

ǃᮄথ⮙՟

DST

Ẕ⌟⥛䖒ࠄ

20%

Ǆ✊

㗠Ⳃࠡ

DST

Ẕ⌟⥛ҡ䕗Ԣˈᮄথ⮙՟੠໡⊏⮙՟ⱘ'67 Ẕ⌟⥛ߚ߿Ў

3%

੠

20%

ˈ䖰䖰ԢѢ䘣ࠊ㒧Ḍ⮙ܼ⧗䅵 ߦⱘⳂᷛǄᖿ䗳Ẕ⌟ᡔᴃⱘᑨ⫼ৃҹՓ䆞ᮁ㛑࡯ᕫࠄ ᰒ㨫ᦤ催ˈ՟བ䍞फ

2013

ᑈ

81%

ⱘ

MDR-TB

᡹ਞ⮙՟

⬅

Xpert MTB/RIF

䆩偠䆞ᮁǄߚᵤ㒧ᵰᰒ⼎ˈ

DST

Ẕ⌟

⥛ҡ೼ϡᮁᦤ催ᑊ䗤⏤㽚Ⲫ催亢䰽Ҏ㕸Ǆ໮᭄೑ᆊ䍋

߱ᇚ

PMDT

ⱘ䞡⚍䲚ЁѢ໡⊏⮙՟ˈ಴Ў㽕থ⦄ᮄথ⮙

՟Ёⱘ

MDR-TB

⮙՟೼㽓໾ᑇ⋟ऎඳᰃϔ乍Ꮌ໻ᣥ៬Ǆ ሑㅵᮄথ⮙՟Ё

MDR-TB

⮙՟ⱘ↨՟䕗ԢˈԚᮄথ⮙՟

Ё

MDR-TB

⮙՟ⱘ㒱ᇍ᭄ᕜ催Ǆࠊᅮձ䴴⦄᳝㒣䌍੠Ҏ

㸼3. 2013ᑈ㽓໾ᑇ⋟ऎඳ䚼ߚ೑ᆊ*MDR-TB⮙՟੠RR-TB⮙՟Ԅ䅵⮙՟᭄੠᡹ਞ⮙՟᭄ǃ᡹ਞ⮙՟᭄ऴԄ䅵⮙

՟᭄ⱘ↨՟ǃ⊏⭫⮙՟᭄ऴ᡹ਞ⮙՟᭄ⱘ↨՟

^噛

೑ᆊ੠ഄऎ

Ԅ䅵 ᡹ਞ⮙՟᭄ ᡹ਞ⮙՟ऴԄ䅵⮙՟ⱘ↨՟

⊏⭫⮙՟᭄

ᮄথ⮙՟ ໡⊏⮙՟ ড়䅵

ᮄথ

⮙՟

໡⊏

⮙՟ ড়䅵^噜

ᮄথ⮙՟ ໡⊏⮙՟ ড়䅵

Ҏ᭄ (95% CI) Ҏ᭄ (95% CI) Ҏ᭄ (95% CI) Ҏ᭄ (95% CI) Ҏ᭄ (95% CI) Ҏ᭄ (95% CI) Ҏ᭄

%ऴẔߎ

⮙՟᭄ⱘ

↨՟

▇໻߽Ѯ 16 (8–27) 1 (0–7) 17 (8–26) 13 3 24 81 (48–144) 300 (43–NA) 141 (92–300) 22 92

᭛㦅 1 (0–6) 0 (0–3) 1 (0–3) 1 0 1 100 (17–NA) – (0–NA) 100 (33–NA) 0 0

᷀ඨᆼ 320 (270–580) 180 (68–370) 510 (270–740) – – 121 – (NA–NA) – (NA–NA) 24 (16–45) 121 100

Ё೑ 45 000 (48 000–55 000) 9200 (7800–11 000) 54 000 (48 000–61 000) 1612 2571 4183 4 (3–5) 28 (23–33) 8 (7–9) 2184 52

佭␃ 34 (26–52) 9 (3–20) 43 (26–59) 28 7 35 82 (54–133) 78 (35–233) 81 (59–135) 22 63

▇䮼 7 (4–16) 4 (1–10) 11 (4–18) 6 3 10 86 (38–300) 75 (30–300) 91 (56–250) 8 80

ᑧܟ㕸ቯ 0 (0–1) 0 (0–0) 0 (0–1) 0 0 2 – (0–NA) – (NA–NA) NA (200–NA) 0 0

᮹ᴀ 110 (150–160) 100 (72–130) 200 (150–560) 42 22 64 38 (26–67) 22 (17–31) 32 (25–43) – –

㗕ᣱ 160 (160–230) 65 (56–75) 220 (160–290) 0 7 7 0 (0–0) 11 (9–12) 3 (2–4) 4 57

偀ᴹ㽓Ѯ 19 (0–120) 0 (0–340) 19 (0–57) 80 5 277 421 (67–NA) NA (1–NA) 1458 (486–NA) 49 18

偀㒡ᇨ㕸ቯ 2 (0–9) 0 (0–5) 2 (0–5) 1 0 1 50 (11–NA) – (0–NA) 50 (20–NA) 1 100

㩭স 33 (210–59) 210 (180–240) 240 (210–280) 64 177 257 194 (108–400) 84 (74–98) 107 (92–122) 192 75

ᮄ㽓݄ 1 (0–5) 2 (0–5) 3 (0–6) 1 1 3 100 (20–NA) 50 (20–NA) 100 (50–NA) 2 67

Ꮹࢇ 0 (0–3) 0 (0–0) 0 (0–3) 0 0 1 – (0–NA) – (NA–NA) NA (33–NA) 0 0

ᏈᏗѮᮄ޴ݙѮ 560 (890–800) 570 (480–650) 1100 (890–1400) – – 119 – (NA–NA) – (NA–NA) 11 (8–13) 145 122 㧆ᕟᆒ 4400 (6900–6000) 4100 (3000–5500) 8500 (6900–10 000) 10 1349 3962 <1 (<1–<1) 33 (25–45) 47 (40–57) 2262 57

䶽೑ 780 (1600–980) 1200 (850–1600) 1900 (1600–2300) 466 518 984 60 (48–78) 43 (32–61) 52 (43–62) 951 97

ᮄࡴവ 17 (9–30) 3 (0–12) 20 (9–31) 14 4 18 82 (47–175) 133 (33–NA) 90 (58–200) 15 83

䍞फ 3000 (4100–4100) 2100 (1500–2600) 5100 (4100–6100) 40 997 1204 1 (<1–2) 47 (38–66) 24 (20–29) 948 79

㽓໾ᑇ⋟ऎඳ 53 000 (47 000–75 000) 18 000 (15 000–21 000) 71 000 (47 000–94 000) 2379 5664 11 153 4 (3–8) 31 (27–38) 16 (12–24) 6926 62 CIৃֵऎ䯈MDR-TB㗤໮㥃㒧Ḍ⮙NAϡ䗖⫼Prev໡⊏㒧Ḍ⮙⮙՟RR-TB߽⽣ᑇ㗤㥃㒧Ḍ⮙Ǆ

*2013ᑈ᳝MDR-TB⮙՟᡹ਞⱘ೑ᆊǄ

噛䰸њԄ䅵⮙՟߫ҹ໪ˈ݊Ҫ৘߫ഛࣙ৿ҙ㒣XpertẔ⌟ⱘRR-TB⮙՟ˈMDR-TBᘏ⮙՟᭄ࣙᣀ㚎໪㒧Ḍ⮙⮙՟ҹঞ⊏⭫ᓔྟৢ਼ҹϞ䞛䲚ᷛᴀⱘ⮙՟Ǆ

噜ড়䅵߫ࣙᣀ⊏⭫৆ϡᯢⱘ⮙՟Ǆ

(8)

MDR-TB᡹ਞ⮙՟᭄੠⮙՟⊏⭫᭄ਜ๲䭓ᗕ࢓ˈ

㸼 ᯢ ৘ ೑ ᳝ ᛣ ᜓ ᠽ ሩ

PMDTǄ ᴀ ᭛ ߚ ᵤ 㒧 ᵰ ᰒ ⼎ ˈ

㒧Ḍ⮙᡹ਞ⮙՟᭄ℷ೼๲ࡴˈԚⳂࠡ೼PMDTЁ᡹ਞ ⱘMDR-TB⮙՟᭄ҙऴԄ䅵⮙՟᭄ⱘ16%Ǆ㗗㰥ࠄ೑ᆊ ᬓ⊏ᡓ䇎ҹঞЎMDR-TBᦤկ80%ҹϞ㒣䌍ⱘ㒣䌍䌘

ࡽ乍Ⳃⱘ䭓ᳳৃᣕ㓁ᗻˈᠽሩPMDT ҡ✊ᄬ೼Ⳍᔧ໻ⱘ ᣥ៬Ǆ

ᑨ⊼ᛣⱘᰃˈᴀ᭛ⱘߚᵤ᭄᥂ϡᅠᭈˈ᳾ࣙᣀ᠔

᳝೑ᆊⱘ᭄᥂Ǆ಴ℸˈᇍ䖭ѯ᭄᥂ⱘ㾷䞞ᑨ䆹ᜢ䞡Ǆ

MDR-TBᰃ⬅ѢҎⱘ㸠Ў䗴៤ⱘˈা᳝㾷އњᇐ

㟈݊থ⫳ⱘḍᴀॳ಴ˈᇍ݊᥻ࠊᠡ㛑໳পᕫ៤ࡳǄᑨ ᇚMDR-TB乘䰆ࣙᣀࡴᔎ෎ᴀⱘ㒧Ḍ⮙᥻ࠊ԰Ўᑨ ᇍMDR-TBⱘЁᖗㄪ⬹ǄᠽሩPMDTᖙ乏䗮䖛ᑇ㸵ⱘᮍ ᓣ䗤ℹᬍ䖯᠔᳝Ⳍ݇ⱘ݇䬂ℹ偸Ǆ㒧Ḍ⮙᥻ࠊ㒣䖛њ

޴कᑈˈⳂࠡᏆ㒣䖯ܹথሩ᳔ᖿⱘ䰊↉ˈ䴶Јᕜ໮ᴎ 䘛Ǆ៥Ӏᢹ᳝ᮄⱘ䆞ᮁᡔᴃǃᮄⱘ⊏⭫㥃⠽ǃᮄⱘㄪ

⬹Ǆ಴ℸˈЎњ乘䰆MDR-TB੠ᠽሩPMDTˈࡴᔎ䋶ᬓ

੠ᡔᴃ䌘⑤ⱘᡩܹ㟇݇䞡㽕Ǆ

෎䞥 ᮴Ǆ ㄝˈ䚼ߚ⮙՟ᇮᥦ೼⊏⭫ㄝ׭ৡऩЁǄ⊏⭫㛑࡯៪

䆌ϡӮ䱣ⴔ⹂䆞㛑࡯ᇸ݊ᰃ

Xpert MTB/RIF

䆩偠Ẕ⌟

㛑࡯ⱘᖿ䗳ᦤ催㗠ᦤ催Ǆ঺ϔϾ䗴៤⮙՟᳾㛑ᕫࠄ⊏

⭫ⱘॳ಴Ў⹂䆞⮙՟༅䆓ˈ䖭ৃ㛑⬅Ѣ⮙՟ϡᯧࠄ䖒

PMDT

Ёᖗǃ䆞ᮁ੠⊏⭫䚼䮼㔎Уण䇗ǃⳈ᥹੠䯈᥹⊏

⭫䌍⫼᠔䗴៤ⱘ㒣⌢䋳ᢙᇐ㟈Ǆ䖭ѯ᳾㛑᥹ফ⊏⭫ⱘ

⮙՟䖨ಲ⼒ऎᑊ㒻㓁Ӵ᪁

MDR-TB

Ǆ೼䆞ᮁ㛑࡯ᦤ催ⱘ ৠᯊˈ䖬䳔ࡴᔎ㥃⠽੠⊏⭫᳡ࡵⱘկ㒭ˈخߎՓ⊏⭫

㛑࡯Ϣ䆞ᮁ㛑࡯Ⳍऍ䜡ⱘᬓ⊏ᡓ䇎㟇݇䞡㽕Ǆℸ໪ˈ 䳔㽕ᶹ⏙ᇐ㟈催༅䆓⥛ⱘḍᴀॳ಴ᑊќҹ㾷އǄЎ㾷 އ䖭ѯ䯂乬ˈ䳔㽕ḍ᥂

WHO

⍜䰸㒧Ḍ⮙ㄪ⬹^[14]ᦤߎⱘ

᳝࡯ᬓㄪ੠ᬃᣕ㋏㒳ˈᇚҹ⮙՟ЎЁᖗⱘ㒧Ḍ⮙㓐ড়

⊏⭫੠乘䰆Ꮉ԰㨑ࠄᅲ໘Ǆऩ䴴೑ᆊ㒧Ḍ⮙乍Ⳃᴀ䑿

ৃ㛑᮴⊩㾷އ䆞ᮁ㛑࡯੠⊏⭫㛑࡯ϡऍ䜡ⱘ䯂乬Ǆ ᠔᳝᥹ফ⊏⭫ⱘMDR-TB⮙՟ᖙ乏ᅠ៤ᭈϾ⊏⭫

䖛⿟Ǆᴀ᭛ߚᵤᰒ⼎ˈ㽓໾ᑇ⋟ऎඳ2011ᑈMDR-TB

⮙՟⊏⭫៤ࡳ⥛ҙЎ52%Ǆ䖭Ϣܼ⧗ᑇഛ⊏⭫៤ࡳ⥛

48%ⳌԐ^[1]Ǆӫ໮MDR-TB⮙՟༅䆓

21%៪᳾㒣

䆘Ԅ17%ᰃ⊏⭫៤ࡳ⥛Ԣⱘ䚼ߚॳ಴ˈᑊᇐ㟈㗤㥃㒧Ḍ㦠᷾ⱘᣕ㓁Ӵ᪁Ǆ⊏⭫៤ࡳ⥛Ԣ㟈ՓPMDTⱘ

᳝ᬜᗻফࠄᕅડǄ✊㗠ˈ᷀ඨᆼ੠䍞फ䖥ᑈᴹⱘ⊏⭫

៤ࡳ⥛೼70%ҹϞˈ㸼ᯢMDR-TB⊏⭫៤ࡳ⥛ᰃ᳝ৃ㛑 ᦤ催ⱘǄ

㸼 4. 2013 ᑈ㽓໾ᑇ⋟ऎඳ䚼ߚ೑ᆊ *MDR-TB ⮙՟੠ RR-TB ⮙՟Ёᇍᡫ㒧ḌѠ㒓㥃⠽㗤㥃ⱘ⮙՟᭄੠↨՟ҹঞ XDR-TB ⮙՟᭄੠↨՟

೑ᆊ੠ഄऎ ᥹ফѠ㒓㥃⠽'67Ẕ⌟ⱘ⮙՟ ᇍ)4㗤㥃ⱘ⮙՟ ᇍѠ㒓⊼ᇘࠖ㗤㥃ⱘ⮙՟ ;'57%

Ҏ᭄ ऴ⊏⭫⮙՟ⱘ↨՟˄˅ Ҏ᭄ ऴẔ⌟⮙՟ⱘ↨՟˄˅ Ҏ᭄ ऴẔ⌟⮙՟ⱘ↨՟˄˅ Ҏ᭄ ऴẔ⌟⮙՟ⱘ↨՟˄˅

▇໻߽Ѯ 12 55 2 17 1 8 0 –

᭛㦅 – – – – – – – –

᷀ඨᆼ – – – – – – – –

Ё೑ – – – – – – – –

佭␃ 26 118 2 8 3 12 1 4

▇䮼 7 88 0 – 0 – 0 –

ᑧܟ㕸ቯ 0 – 0 – 0 – 0 –

᮹ᴀ – – – – – – – –

㗕ᣱ 4 100 1 25 0 _ 0 –

偀ᴹ㽓Ѯ 113 231 12 11 2 2 1 <1

偀㒡ᇨ㕸ቯ – – – – – – – –

㩭স 113 59 6 5 15 13 5 4

ᮄ㽓݄ 2 100 0 – 0 – 0 –

Ꮹࢇ 0 – 0 – 0 – 0 –

ᏈᏗѮᮄ޴ݙѮ 73 50 1 1 2 3 – –

㧆ᕟᆒ 927 41 59 6 38 4 5 <1

䶽೑ 838 88 158 19 112 13 85 10

ᮄࡴവ 12 80 0 – 0 – 0 –

䍞फ 199 21 29 15 23 12 10 5

㽓໾ᑇ⋟ऎඳ 2326 34 270 12 156 8 107 5

DST㥃ᬣ䆩偠FQ⇳஍䇎䝂MDR-TR㗤໮㥃㒧Ḍ⮙RR-TB߽⽣ᑇ㗤㥃㒧Ḍ⮙XDR-TBᑓ⊯㗤㥃㒧ḌǄ

* 2013ᑈ᳝MDR-TB⮙՟᡹ਞⱘ೑ᆊǄ

(9)

খ㗗᭛⤂˖

1. Global Tuberculosis Report 2014. Geneva, World Health Organization, 2014 (http://www.who.int/tb/publications/global_

report/gtbr14_main_text.pdf, accessed 5 December 2014).

2. Companion handbook to the WHO guidelines for the programmatic management of drug-resistant tuberculosis.

Geneva, World Health Organization, 2014 (http://apps.who.int/iris/

bitstream/10665/130918/1/9789241548809_eng.pdf?ua=1, accessed 5 December 2014).

3. Nathanson E et al. Adverse events in the treatment of multidrug- resistant tuberculosis: results from the DOTS-Plus initiative.

International Journal of Tuberculosis and Lung Disease, 2004, 8:1382–1384. pmid:15581210

4. Wingfield T et al. Defining catastrophic costs and comparing their importance for adverse tuberculosis outcome with multi-drug resistance: a prospective cohort study, Peru. PLoS Medicine, 2014, 11:e1001675. doi:10.1371/journal.pmed.1001675 pmid:25025331

5. Abubakar I et al. Drug-resistant tuberculosis: time for visionary political leadership. Lancet, 2013, 13:529–539. doi:10.1016/

S1473-3099(13)70030-6 pmid:23531391

߽Ⲟކさ

᳾⬇᡹Ǆ 㟈䇶

ᛳ䇶

Matteo Zignol

੠

Anna Dean

Ўᴀ᭛߱〓ᦤկⱘᓎ 䆂Ǆᛳ䇶㽓໾ᑇ⋟ऎඳ৘៤ਬ೑೑ᆊ㒧Ḍ⮙᥻ࠊ乍 ⳂǄ

ᓩ⫼ᴀ᭛ഄഔ˖

Islam T et al. Drug-resistant tuberculorsis in the WHO Western Pacific Region. Western Pacific Surveillance and Response Journal, 2014, 5(4):34–46. doi:10.5365/

wpsar.2014.5.4.007

೒ 5. 2007–2013 ᑈ WHO 㽓໾ᑇ⋟ऎඳ䚼ߚ೑ᆊ *MDR-TB ੠ RR-TB ᡹ਞ⮙՟੠㒇ܹ⊏⭫ᚙމᯊ䯈ߚᏗ

DST㥃ᬣ䆩偠FQ⇳஍䇎䝂MDR-TR㗤໮㥃㒧Ḍ⮙RR-TB߽⽣ᑇ㗤㥃㒧Ḍ⮙Ǆ

* 2013ᑈ᡹ਞ10՟ҹϞMDR-TB⮙՟ⱘ೑ᆊǄ

▇໻߽Ѯ Ё೑ 佭␃ ᮹ᴀ

偀ᴹ㽓Ѯ 㩭স ᏈᏗѮᮄ޴ݙѮ 㧆ᕟᆒ

䶽೑ ᮄࡴവ 䍞फ 㽓໾ᑇ⋟ऎඳ

0 10 20 30 40

0 1000 2000 3000 4000

0 10 20 30 40

0 20 40 60 80

0 50 100 150 200

0 100 200 300

0 50 100 150 200

0 1000 2000 3000 4000

0 250 500 750 1000 1250

2007 2009 2011 2013

0 5 10 15 20 25

2007 2009 2011 2013

0 250 500 750 1000 1250

2007 2009 2011 2013

0 2500 5000 7500 10000 12500

2007 2009 2011 2013

⹂䆞⮙՟ 㒇ܹ⊏⭫ⱘ⮙՟

0'57%੠557%⮙՟

(10)

10. Xpert MTB/RIF implementation manual: technical and operational ‘how-to’: practical considerations. Geneva, World Health Organization, 2014 (http://apps.who.int/iris/bit stream/10665/112469/1/9789241506700_eng.pdf, accessed 5 December 2014).

11. Peng RD, Dominici F, Zeger SL. Reproducible epidemiologic research. American Journal of Epidemiology, 2006, 163:783–

789. doi:10.1093/aje/kwj093 pmid:16510544

12. Groves T, Godlee F. Open science and reproducible research. BMJ (Clinical Research Ed.), 2012, 344:e4383.

pmid:22736475

13. The Global Plan to Stop TB 2011–2015. Geneva, World Health Organization, 2010 (http://www.stoptb.org/assets/documents/

global/plan/TB_GlobalPlanToStopTB2011-2015.pdf, accessed 5 December 2014).

14. WHA 67.1. Global strategy and targets for tuberculosis prevention, care and control after 2015. Geneva, World Health Organization, 2014 (http://apps.who.int/gb/ebwha/pdf_files/

WHA67/A67_R1-en.pdf, accessed 5 December 2014).

6. Regional Strategy to Stop Tuberculosis in the Western Pacific 2011–2015. Manila, World Health Organization Regional Office for the Western Pacific, 2011 (http://www.wpro. who.

int/tb/documents/policy/2010/regional_strategy/en/, accessed 5 December 2014).

7. Hiatt T, Nishikiori N. Epidemiology and control of tuberculosis in the Western Pacific Region: analysis of 2012 case notification data.

Western Pacific Surveillance and Response Journal, 2014, 5:25–

34. doi:10.5365/wpsar.2014.5.1.013 pmid:24734214

8. Definitions and reporting framework for tuberculosis – 2013 revision. Geneva, World Health Organization, 2013 (http://apps.

who.int/iris/bitstream/10665/79199/1/9789241505345_eng.

pdf, accessed 5 December 2014).

9. Automated real time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children, policy update.

Geneva, World Health Organization, 2013 (http://apps.who.int/

iris/bitstream/10665/112472/1/9789241506335_eng.pdf, accessed 5 December 2014).

೒ 6. 2007–2011 ᑈ WHO 㽓໾ᑇ⋟ऎඳ䚼ߚ೑ᆊ *MDR-TB ੠ RR-TB ⮙՟⊏⭫ᬜᵰᯊ䯈ߚᏗ

DST㥃ᬣ䆩偠FQ⇳஍䇎䝂MDR-TR㗤໮㥃㒧Ḍ⮙RR-TB߽⽣ᑇ㗤㥃㒧Ḍ⮙Ǆ

* 2013ᑈ᳝MDR-TB⮙՟᡹ਞϨ᡹ਞ2011ᑈ⮙՟⊏⭫ᬜᵰⱘ೑ᆊǄ

3HUFHQWDJH

▇໻߽Ѯ Ё೑ 佭␃ ᮹ᴀ

▇䮼㗕ᣱ 偀ᴹ㽓Ѯ 偀㒡ᇨ㕸ቯ

㩭স ᮄ㽓݄ ᏈᏗѮᮄ޴ݙѮ 㧆ᕟᆒ

䶽೑ ᮄࡴവ 䍞फ 㽓໾ᑇ⋟ऎඳ

2007 2008 2009 2010 2011 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011 2007 2008 2009 2010 2011

100

75

50

25

0

100

75

50

25

0

100

75

50

25

0

100

75

50

25

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⊏⭫ᬜᵰ Not evaluated Lost to follow-up Failed Died Success

᳾䆘Ԅ

༅䆓

⊏⭫༅䋹

⅏ѵ

⊏⭫៤ࡳ

(11)

೒7. 2007–2013ᑈWHO㽓໾ᑇ⋟ऎඳ䚼ߚ೑ᆊMDR-TB੠RR-TB㒣䌍ᴹ⑤ঞᑈӑߚᏗ

MDR-TR㗤໮㥃㒧Ḍ⮙RR-TB߽⽣ᑇ㗤㥃㒧Ḍ⮙Ǆ

* 2013ᑈ᡹ਞ10՟ҹϞMDR-TB⮙՟ⱘ೑ᆊǄ

0 10000 20000 30000 40000 50000

0 100 200 300 400 500

0 200 400 600 800

0 500 1000 1500

0 200 400 600

0 5000 10000 15000 20000

0 1000 2000 3000 4000 5000

2007 2009 2011 2013

0 1000 2000 3000 4000 5000

2007 2009 2011 2013

0 20000 40000 60000 80000

2007 2009 2011 2013

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Ё೑ 佭␃ 偀ᴹ㽓Ѯ

㩭স ᏈᏗѮᮄ޴ݙѮ 㧆ᕟᆒ

䶽೑ 䍞फ 㽓໾ᑇ⋟ऎඳ

ᬓᑰ㒣䌍䴲ᬓᑰ㒣䌍㒣䌍ᬃߎ