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首页> 外文期刊>感染症学雑誌 >新しい結核対策 国立感染症研究所ハンセン病研究センター
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新しい結核対策 国立感染症研究所ハンセン病研究センター

机译：国立传染病研究所汉森氏病研究中心抗结核新措施

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The 1951 Tuberculosis Control Law of Japan was amended extensively and has been in effect since April, 2005. The revision of the National Tuberculosis Program (NTP) is to respond to the tremendous changes that have occurred during the last 50 years in tuberculosis epidemiology and in the environment in tuberculosis control implementation. In this review, the main points and framework of the revisions were summarized and the perspective of the development of new technical innovations relevant to each area of the revised TB control legislation is discussed. Also,challenges of Japan's NTP in the recent future are discussed,including the controversies over the proposed abolishment of the Tuberculosis Control Law,1.Immunization, In the revision of NTP,the BCG vaccination of elementary school and junior-high school entrants was discontinued. In order to strengthen the early primary vaccination for infants, the new Law has adopted the direct vaccination scheme omitting tuberculin testing prior to immunization. This program is implemented to young babies, i.e.less than six months old,as defined by the decree. It is a heavy responsibility for the municipalities to ensure the high coverage of immunization when the period of legal vaccination is rather strictly limited practically to the fourth to sixth months after birth.The safe direct vaccination is another new challenge where appropriate management of the Koch's phenomenon or similar reactions should be warranted.2Chemoprophylaxis,Though unfortunately suspended for some legal reason currently,the expansion and improvement of chemoprophylaxis,or treatment of latent tuberculosis infection, to cover anyone with higher risk of clinical development of TB would have a tremendous effect in Japan, especially since 90% of patients who developed TB were infected tens of years ago. The technical innovations in diagnosis of TB infection such as QuantiFERON will be very helpful, Development of new drugs or drug regimens for this purpose is also expected.3.Case detection. The "indiscriminate" screening scheme in the periodic mass health examination has been replaced with a selective one.Only subjects aged 65 or older are eligible for the screening, supplemented with selected occupational groups who are considered to become source of infection,should they develop tuberculosis,such as health-care providers and school teachers. Local autonomies are also responsible for offering screening to the socio-economic high-risk populations,such as homeless people,slum residents, day laborers,and/or workers in small businesses,as decided by the autonomies at their disposal. Another important mode of active case-finding,i,e, contact investigation has been legally enforced so that anybody cannot refuse to be examined by the Health Center. This investigation service will be greatly enhanced by such new technologies as DNA fingerprinting of TB bacilli and a new diagnostic of TB infection. Regarding the clinical service of the symptomatic patients that detect 75% of new cases currently will be improved in its quality by introducing an external quality assurance system of commercial bacteriological laboratory services.4.Treatment and patient support: The revised NTP clearly states the government's responsibility for treating TB patients in close cooperation with a doctor, in the framework of the DOTS Japan version. While the development of new anti-tuberculosis drugs will be realized in the near future, Japan still has to overcome the issues of improper practice of treatment, as well as the government's slow process for approving drugs to be used for multi-drug resistant TB and non-tuberculous mycobacterioses, such as quinolones,macrolides and others.5.Prefectural TB Control Plan:In order to respond to the specific issues of tuberculosis problem in the respective prefectures in terms of epidemiology or in available resources,the Law requests every prefecture to develop and implement its own TB control plan.The rath
机译：1951年的《日本结核病控制法》经过了广泛修改，自2005年4月起生效。《国家结核病计划》（NTP）的修订旨在应对过去50年间在结核病流行病学和医学领域所发生的巨大变化。环境在结核病控制中的实施。在这次审查中，总结了修订的要点和框架，并讨论了与修订后的结核病控制立法的每个领域相关的新技术创新的发展前景。此外，还讨论了日本NTP近期面临的挑战，包括对拟议中的《结核病控制法》的废除的争议; 1。免疫性，在NTP修订版中，中小学生的BCG疫苗接种已中止。为了加强对婴儿的早期初次疫苗接种，新法律采用了直接疫苗接种计划，在免疫前省略了结核菌素检测。该法令适用于法令所定义的未满六个月的婴儿。当合法疫苗接种的时间实际上严格限制在出生后的第四到第六个月时，市政当局有很大的责任确保高免疫接种率。安全的直接疫苗接种是应对科赫现象的适当管理的另一个新挑战。 2化学预防，尽管目前由于某些法律原因不幸中止，化学预防的扩大和改善，或潜伏性结核病的治疗，以覆盖结核病临床发展风险较高的任何人，在日本将产生巨大影响，尤其是因为数十年前90％的结核病患者被感染。 QuantiFERON等诊断结核感染的技术创新将非常有帮助。为此目的，也有望开发新药或新药物疗法。3．病例检测。定期大众健康检查中的“不加区别”筛查方案已被选择性的筛查方案所取代。只有65岁或65岁以上的受试者才有资格接受筛查，并补充被认为已成为传染源，应发展为结核病的部分职业人群，例如医疗保健提供者和学校老师。当地自治区还负责对社会经济高风险人群（如无家可归者，贫民窟居民，临时工和/或小型企业的工人）进行筛查，这取决于自治区的决定。积极进行病例调查的另一种重要方式，即接触者调查已得到法律强制执行，因此任何人都不能拒绝接受卫生中心的检查。结核病菌的DNA指纹图谱和结核病感染的新诊断等新技术将大大增强这项调查服务。关于有症状患者的临床服务，目前发现75％的新病例，将通过引入商业细菌实验室服务的外部质量保证体系来改善其质量。4。治疗和患者支持：修订后的NTP明确规定了政府的责任在DOTS Japan版本的框架内与医生密切合作治疗TB患者。尽管在不久的将来将实现新的抗结核药物的开发，但日本仍必须克服治疗方法不当的问题，以及日本政府批准用于多药耐药结核病和结核病的药物的缓慢程序。非结核性分枝杆菌，例如喹诺酮类，大环内酯类等。5。州结核病控制计划：为了应对各个州在流行病学或可用资源方面的结核病问题，法律要求每个州制定并实施自己的结核病控制计划。

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