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zoom RSS ロンドンの結核発症 10年で50%増/英国医療事情

<<   作成日時 : 2010/12/23 22:31   >>

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 ランセットに発表された論文によれば、ロンドンは西ヨーロッパで最も結核の多い都市であり、ここ10年で50%も増加したという。
画像 17世紀のロンドンでは肺結核による死亡率が1%もあり、エイズの流行で死亡率が急上昇する現在のアフリカより多かった。
 英国では抗生物質・BCGワクチン・よりよい住宅によって1980年までに征服されると考えられたことから、NHSが監視の手をゆるめた。
 新たな発症はほとんどが移民であり、昨年は28%がアフリカから、27%がインドからの移民であった。ビクトリア朝ロンドンと同様に、粗末な住宅地区で多い。さらに3,600人のホームレスで高い発症率である。また、刑務所では耐性菌の発症が多い。
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英国はヨーロッパで最も不健康な国である/英国医療事情
http://kurie.at.webry.info/201012/article_17.html
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London: Tuberculosis Cases Have Increased 50 Percent in Last Decade, Lancet Says
http://www.nytimes.com/2010/12/21/health/21global.html

By DONALD G. McNEIL Jr.
Published: December 20, 2010

London is the tuberculosis capital of Western Europe, according to a recent article in the medical journal Lancet, which said that cases there increased 50 percent in the last decade.

The situation is “reminiscent of the unexpected outbreaks of multidrug-resistant tuberculosis in New York and California prisons in the early 1990s,” wrote Dr. Alimuddin Zumla, an infectious-disease specialist at the University College London Medical School.

In the 17th century, tuberculosis ― called “the white plague” for its victims’ pallor ― is thought to have killed 1 percent of London’s population each year, a far higher death rate than in Africa now, where the epidemic has soared along with AIDS. By 1980, it was considered conquered in Britain by antibiotics, the BCG vaccine and better housing, and the National Health Service cut back on surveillance.

Now, most of the new cases are in immigrants. Last year, 28 percent were in people who arrived from Africa, and 27 percent in people from India.

As in Victorian London, it is more common in districts with poor housing. But it is also very common among the estimated 3,600 homeless who sleep in London’s streets and parks nightly, who are also at higher risk because they more often have drug and alcohol problems, mental illness and AIDS.

And it is becoming more common in prisons, where drug-resistant strains are being diagnosed among both prisoners and guards.

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The Lancet, Early Online Publication, 17 December 2010
doi:10.1016/S0140-6736(10)62176-9Cite or Link Using DOI

The white plague returns to London―with a vengeance

Alimuddin Zumla

In 1660, John Bunyan (1628―88), an English Christian writer and preacher, described tuberculosis as “The Captain among these men of death” when tuberculosis case rates in London had reached a phenomenal 1000 per 100 000 population per year,1 far more than current rates of 340 per 100 000 in sub-Saharan African countries.2 During the 19th century, the white plague, as tuberculosis was named in Victorian Britain (due to the loss of skin colour seen in London tuberculosis patients), continued to ravage Britain, and up to 25% of deaths in Europe were caused by this disease. The death toll from tuberculosis began to fall in London at the start of the 20th century, as living standards (better housing, nutrition, and economic status) improved; subsequent tuberculosis control was achieved by the introduction in the early 1960s of antituberculosis drugs, improved health services, and BCG vaccination. By the early 1980s, tuberculosis was considered to be conquered in the UK and National Health Service (NHS) tuberculosis services were scaled down considerably.
Presently, 1?7 million people die of tuberculosis globally each year and the disease is out of control in 22 high-burden countries worldwide.2 Easy travel and migration, and poor socio-economic and living conditions in certain groups, have allowed the disease to re-surface as a public health problem in all European countries. The incidence in the UK has gradually increased over the past 15 years. In 2009, over 9000 cases were reported, a rate of 14?6 per 100 000 population.3, 4 This pattern is striking when compared with the general decline in other western European countries; the UK is the only European country where tuberculosis incidence rates continue to rise.3
Tuberculosis has returned to London in force with an increase in the number of cases by nearly 50% since 1999, from 2309 in 1999 to 3450 in 2009,3 accounting for almost 40% of all tuberculosis cases in the UK.3, 4 Because the current gold standard for diagnosis (sputum microscopy and culture) only detects up to 70% of active cases, and London general practitioners require education and heightened awareness to improve diagnosis,5 the number of cases reported is underestimated. Drug-resistant tuberculosis is also becoming an important problem in London. During the past 10 years, an ongoing outbreak of isoniazid-resistant tuberculosis in hard-to-reach groups is spreading, with 172 isoniazid-resistant cases reported in London in 2009.6 Ominously, there were a further 58 cases of multidrug-resistant tuberculosis in 2009.7



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