7/29/2019 TB Sem 1 Lecture

1/81

1843-1910

1882.

1890. 1905.

och R. Die Aetiologie der Tuberculose.

Berl.Klin.Wschr., 1882; 15: 221-230.

7/29/2019 TB Sem 1 Lecture

2/81

1.

2.

3.

7/29/2019 TB Sem 1 Lecture

3/81

7/29/2019 TB Sem 1 Lecture

4/81

1888-1973

1943 .

1952 .

7/29/2019 TB Sem 1 Lecture

5/81

Mycobacterium tuberculosis 85-90%

Mycobacterium bovis 10-15%

Mycobacterium avium 3%

7/29/2019 TB Sem 1 Lecture

6/81

Mycobacterium tuberculosis

complex

M.tuberculosis

M.bovis

M.africanum M.microti

M. canettii,

M. pinnipedii

M. caprae

7/29/2019 TB Sem 1 Lecture

7/81

7/29/2019 TB Sem 1 Lecture

8/81

7/29/2019 TB Sem 1 Lecture

9/81

1,5 .2-3 .

5 . 25 .

7/29/2019 TB Sem 1 Lecture

10/81

90-95%

7/29/2019 TB Sem 1 Lecture

11/81

7/29/2019 TB Sem 1 Lecture

12/81

7/29/2019 TB Sem 1 Lecture

13/81

-1

-

7/29/2019 TB Sem 1 Lecture

14/81

7/29/2019 TB Sem 1 Lecture

15/81

7/29/2019 TB Sem 1 Lecture

16/81

-

7/29/2019 TB Sem 1 Lecture

17/81

7/29/2019 TB Sem 1 Lecture

18/81

.:

7/29/2019 TB Sem 1 Lecture

19/81

7/29/2019 TB Sem 1 Lecture

20/81

, ,

( 65 )

7/29/2019 TB Sem 1 Lecture

21/81

( .

,)

12

,

7/29/2019 TB Sem 1 Lecture

22/81

() 100 000

< 10

10-24

25-74

75-124

125-198 ; ,,. 2007.

,

(WHO/HTM/TB/2007.376)

STAKHANOV2010

7/29/2019 TB Sem 1 Lecture

23/81

,

. , ,

.

7/29/2019 TB Sem 1 Lecture

24/81

, ,

.

..

.

7/29/2019 TB Sem 1 Lecture

25/81

.2001 .

7/29/2019 TB Sem 1 Lecture

26/81

.2001 .

Wells W.E. On air-bome infection. Stady II.Droplets and droplet nuclei. Am.J.Hyg., 1934;

20:611-8 , .

1 = 5 . =>

50% 30

.

7/29/2019 TB Sem 1 Lecture

27/81

.2001 .

, , , ,

\ .

7/29/2019 TB Sem 1 Lecture

28/81

Accuracy, ,

- definite case of TB.

Age-specific rate

. Case (, ). /

- notification .

. / Case detectionrate ( 1 .

7/29/2019 TB Sem 1 Lecture

29/81

Evidence - . Incidence,

Prevalence, .

. ... 100 .

7/29/2019 TB Sem 1 Lecture

30/81

8 .

2,5-3 .

2 .

7/29/2019 TB Sem 1 Lecture

31/81

100000

()- , 100000

7/29/2019 TB Sem 1 Lecture

32/81

100000

,

7/29/2019 TB Sem 1 Lecture

33/81

(2009 .\2010 .)

86,2 \77,4 100.

185,1\178,7 100.

16,5\15,4 100 .

.

-

; 2010.

7/29/2019 TB Sem 1 Lecture

34/81

www.mednet.ru:

109 904 .

141, 9 .

. 2 858 .

- 4 736 .

11,6 .

2010 .

http://www.mednet.ru/http://www.mednet.ru/http://www.mednet.ru/http://www.mednet.ru/

7/29/2019 TB Sem 1 Lecture

35/81

2010 .\2011 . 45,5\ 40,8 100 .

( 27,6\ 24,2 100.)

68,7\ 58,6 100. (25,8\ 20,6 100 .)

5,6\ 4,2 100 .( - 3,1 \ 2,6 100.)

.

7/29/2019 TB Sem 1 Lecture

36/81

-

(2010 .)

:

- 15,2 100 .*

:

- 36,3 100 .

(2011 .)

:

22,0 100 .

:

27,5 100 .

*

7/29/2019 TB Sem 1 Lecture

37/81

2011 .( . ) : 47,3%

:

18,7%

: 7,3%

:8,0%

207

.

7/29/2019 TB Sem 1 Lecture

38/81

7/29/2019 TB Sem 1 Lecture

39/81

-

50-78% .

7/29/2019 TB Sem 1 Lecture

40/81

7/29/2019 TB Sem 1 Lecture

41/81

- ,

, ,

.

.

7/29/2019 TB Sem 1 Lecture

42/81

- .

.., 1999.

-.

.. .. ,

,,,, -.

7/29/2019 TB Sem 1 Lecture

43/81

2007 .

327899-

, 2008 . 440000

-

, -,

, , ,

,

.

2015 500 . (?)-.

(50% )

7/29/2019 TB Sem 1 Lecture

44/81

327899 -: 1796

, - 594

: 7992 ( 2%

), 170 1488, ( 200)

107 ( 133)

, - ,

- 14081

7/29/2019 TB Sem 1 Lecture

45/81

- 30 40%

- - 3%

60 70%

7/29/2019 TB Sem 1 Lecture

46/81

,

,,

,

7/29/2019 TB Sem 1 Lecture

47/81

:

(MDR multidrug resistance)

H R.( , extensive drug resistance) H R

(, , )

7/29/2019 TB Sem 1 Lecture

48/81

:

,, , .

, .

7/29/2019 TB Sem 1 Lecture

49/81

, 2010.:

\ 2010 . .33 30,3%.

( 7-) - 34,7%.

7/29/2019 TB Sem 1 Lecture

50/81

2008 2009 .

65.8

36.8

86.8

21.1 23.7

7.9 7.9

36.8

76.9

56.4

85.7

28.2

23.4

7.9 6.5

56.4

0

10

20

30

40

50

60

70

80

90

100

H R S E K Pt Fn (H+R)

- 2008 - 2009

7/29/2019 TB Sem 1 Lecture

51/81

.

(% )

185264 292

382

805

1393

2481

2001 2002 2003 2004 2005 2006 2007

7/29/2019 TB Sem 1 Lecture

52/81

7/29/2019 TB Sem 1 Lecture

53/81

(%%

)

3528

2777

2099

1590

1336

939

1750

2001 2002 2003 2004 2005 2006 2007

7/29/2019 TB Sem 1 Lecture

54/81

,. (.)

18

32

18

16

12

2003 2004 2005 2006 2007

:

2003 0,02 %

2004 - 0,05 %

2005 - 0,02 %

2006 0,02%

2007 0,01%

7/29/2019 TB Sem 1 Lecture

55/81

, .

(.)

7

10

10

7

20

1

43

10

0

5 66

0

3

1 3

7

0

2

0

2003 2004 2005 2006 2007

7/29/2019 TB Sem 1 Lecture

56/81

.

8413

1671

1563

9074

1446

1682

8634

1346

1614

9277

1347

1585

8258

917

1270

8860

948

1330

0

1000

20003000

4000

5000

6000

7000

8000

9000

10000

2002 2003 2004 2005 2006 2007

1- 1- 1-

7/29/2019 TB Sem 1 Lecture

57/81

185

48295292

1443815192

12552 12687 1253812967

158180174279 267

288464 436 436 281

215

42733743 3746 3800

0

2000

4000

6000

8000

1000012000

14000

16000

2002 2003 2004 2005 2006 2007

1 2 3 1

,

7/29/2019 TB Sem 1 Lecture

58/81

, (2004 )

42%

30%4%

2%

22%

7/29/2019 TB Sem 1 Lecture

59/81

49%51%

7/29/2019 TB Sem 1 Lecture

60/81

2006

..

2005

7/29/2019 TB Sem 1 Lecture

61/81

-

:

2005 . 2004. 6,4 %;

;

10,5 % ;

8,8 %;

9,7 %;

9,6 %.

.

7/29/2019 TB Sem 1 Lecture

62/81

(1992-2006 .)

83,

8

83,

1

35,

842,

948,

0 57,

9 67

,5

74,

0

76,

1 85,

490,

4

88,

5

86,

1

83,

2

83,

1

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

100.

7/29/2019 TB Sem 1 Lecture

63/81

2006 .

0,8%,

1,3%,

5,6%.

7/29/2019 TB Sem 1 Lecture

64/81

7/29/2019 TB Sem 1 Lecture

65/81

. . 1998-2006

68,

4

67,

7

67,

5

65,

8

66,

2

65,

6

64,

7

59,

8

56,

5

1998 1999 2000 2001 2002 2003 2004 2005 2006

.

7/29/2019 TB Sem 1 Lecture

66/81

(2006 )

0,8%(0,9 .)

12,1%(14,3 .)

87,1%(102,0 .)

7/29/2019 TB Sem 1 Lecture

67/81

56-

; 37-

-

; 41,6%

, 9,4%

; 5-

.

(%) 2006

7/29/2019 TB Sem 1 Lecture

68/81

(%). 2006 . .

26,00%

20,60%

20,20%

8,30% 13,70%

6,20% 2,90% 2,10%

0-14 15-17 18-24 25-34

35-44 45-54 55-64 > 65

7/29/2019 TB Sem 1 Lecture

69/81

(%) 2006

7/29/2019 TB Sem 1 Lecture

70/81

(%) 2006 . .

26,20%

16,70%

8,20%

6,60%

15,70%

17,80%

4,80%3,60%

0-14 15-17 18-24 25-34

35-44 45-54 55-64 > 65

. (1992 2006 )

7/29/2019 TB Sem 1 Lecture

71/81

(1992-2006 .)

16,

4

16,

4

16,

1

1

6,

0

16,

219,

1

17,

8

17,

9

1

5,

8

14

,7

9,

4

10,

5

12,

0

13,

1

13,

2

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

100.

2006

7/29/2019 TB Sem 1 Lecture

72/81

. . 2006 .

77,0

143,2

119,1

104,9

75,0

36,6

15-24 25-34 35-44 45-54 55-64 65

,

7/29/2019 TB Sem 1 Lecture

73/81

(1992-2006 .)

11,

41

4,2

16

18

18,

4

1

6,

5

16,

8

17,

7

18,

2

18,

5

18,

5

18,

4

19,

4

22,

7

20,

9

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

1998 2006

7/29/2019 TB Sem 1 Lecture

74/81

. . 1998-2006 .

2

34,

8

246,

6

263,

4

270,

2

272,

8

264,

8

21

9,

4

209

,8

204

,1

1998 1999 2000 2001 2002 2003 2004 2005 2006

7/29/2019 TB Sem 1 Lecture

75/81

(%)

7/29/2019 TB Sem 1 Lecture

76/81

(%)

18,20%

0,10%

36,90%

25,50%

19,30%

I-II III IV V VI

7/29/2019 TB Sem 1 Lecture

77/81

2006

386( 2005 466) .

332 ( 2005 393).

.

2006 . 55219 ,2005. 55976

86% :

7/29/2019 TB Sem 1 Lecture

78/81

:

59%

100

28% 101

300

13%

301

7/29/2019 TB Sem 1 Lecture

79/81

(2007-2011 .)

: (8%)

(34,4%)

-/ (11,4%)

(16,2%)

, (5%)

(8,6%) !!!

(10%) !!! (3,9%)

(2,5%)!!!

2007 2011

7/29/2019 TB Sem 1 Lecture

80/81

2007-2011 .

:

45,9 %

52,4%

1,7%

76 393,5.

2007 2011

7/29/2019 TB Sem 1 Lecture

81/81

2007-2011 .

26300,0. . :

62,80%

37 20%

19,80%

0,60%

79,60%