Global burden of HIV-negative multidrug-and extensively drug-resistant tuberculosis based on Global Burden of Disease Study 2021

Background:Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022.Of particular concern is the emergence of drug-resistant TB,accounting for 15%-20%of TB deaths.It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis(MDRTB)and extensively drug-resistant tuberculosis(XDR-TB),drawing upon the comprehensive Global Burden of Disease(GBD)2021 drug-resistant tuberculosis dataset.Methods:From the GBD 2021,data on incidence,prevalence,disability-adjusted life years(DALYs),and death of MDR-TB and XDR-TB from 1990 to 2021 were collected.We calculated the estimated annual percentage changes in age standardized incidence rate(ASIR)and age-standardized death rate(ASDR),segmented by age,sex,and socio-demographic index(SDI).The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.Results:In 2021,there were an estimated 443,680(95%uncertainty interval[UI]:259,196-766,545)incident cases of MDR-TB,and an estimated 106,818(95%UI:41,612-211,854)death cases of MDR-TB,while there were an estimated 24,036(95%UI:17,144-34,587)incident cases of XDR-TB and 7,946(95%UI:3,326-14,859)death cases of XDR-TB.The incidence and death cases of MDR-TB were lowest in high SDI regions,whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.Conclusion:This study reported the disease burden of drug-resistant TB from 1990 to 2021.Until 2021,drugresistant TB is still a serious problem in low SDI countries,especially for high-risk age populations with highrisk factors.Controlling drug-resistant TB requires effective control strategies and healthcare systems.

How far has the globe gone in achieving One Health?Current evidence and policy implications based on global One Health index

Background:In the 21st century,as globalization accelerates and global public health crises occur,the One Health approach,guided by the holistic thinking of human-animal-environment and emphasizing interdisciplinary collaboration to address global health issues,has been strongly advocated by the international community.An immediate requirement exists for the creation of an assessment tool to foster One Health initiatives on both global and national scales.Methods:Built upon extensive expert consultations and dialogues,this follow-up study enhances the 2022 global One Health index(GOHI)indicator system.The GOHI framework is enriched by covering three indices,e.g.external drivers index(EDI),intrinsic drivers index(IDI),and core drivers index(CDI).The comprehensive indicator system incorporates 13 key indicators,50 indicators,and 170 sub I-indicators,utilizing a fuzzy analytic hierarchy process to ascertain the weight for each indicator.Weighted and summed,the EDI,IDI,and CDI scores contribute to the computation of the overall GOHI 2022 score.By comparing the ranking and the overall scores among the seven regions and across 160 countries/territories,we have not only derived an overall profile of the GOHI 2022 scores,but also assessed the GOHI framework.We also compared rankings of indicators and sub Iindicators to provide greater clarity on the strengths and weaknesses of each region within the One Health domains.Results:The GOHI 2022 performance reveals significant disparities between countries/territories ranged from 39.03 to 70.61.The global average score of the GOHI 2022 is 54.82.The average score for EDI,IDI,and CDI are 46.57,58.01,and 57.25,respectively.In terms of global rankings,countries from North America,Europe and Central Asia,East Asia and Pacific present higher scores.In terms of One Health domains of CDI,the lowest scores are observed in antimicrobial resistance(median:43.09),followed by food security(median:53.78),governance(median:54.77),climate change(median:64.12)and zoonotic diseases(median:69.23).Globally,the scores of GOHI vary spatially,with the highest score in North America while lowest in sub-Saharan Africa.In addition,evidence shows associations between the socio-demographic profile of countries/territories and their GOHI performance in certain One Health scenarios.Conclusion:The objective of GOHI is to guide impactful strategies for enhancing capacity building in One Health.With advanced technology and an annually updated database,intensifying efforts to refine GOHI's data-mining methodologies become imperative.The goal is to offer profound insights into disparities and progressions in practical One Health implementation,particularly in anticipation of future pandemics.

Global antimicrobial resistance:a system-wide comprehensive investigation using the Global One Health Index

Background:Antimicrobial resistance(AMR)is one of the top ten global public health challenges.However,given the lack of a comprehensive assessment of worldwide AMR status,our objective is to develop a One Health-based system-wide evaluation tool on global AMR.Methods:We have further developed the three-hierarchical Global One Health Index(GOHI)-AMR indicator scheme,which consists of five key indicators,17 indicators,and 49 sub-indicators,by incorporating 146 countries'data from diverse authoritative databases,including WHO's Global Antimicrobial Resistance and Use Surveillance System(GLASS)and the European CDC.We investigated the overall-or sub-rankings of GOHI-AMR at the international/regional/national levels for data preprocessing and score calculation utilizing the existing GOHI methodology.Additionally,a correlation analysis was conducted between the GOHI-AMR and other socioeconomic factors.Results:The average GOHI-AMR score for 146 countries is 38.45.As expected,high-income countries(HICs)outperform the other three income groups on overall rankings and all five key indicators of GOHI-AMR,whereas lowincome countries unexpectedly outperform upper-middle-income countries and lower-middle-income countries on the antibiotics-resistant key indicator(ARR)and ARR-subordinate indicators,including carbapenem-,β-lactam-,and quinolone resistance,and even HICs on aminoglycoside resistance.There were no significant differences among the four groups on the environmental-monitoring indicator(P>0.05).GOHI-AMR was positively correlated with gross domestic product,life expectancy,and AMR-related publications,but negatively with natural growth rate and chronic respiratory disease.In contrast to Cyprus,the remarkably lower prevalence of"ESKAPE pathogens"in high-scoring Sweden and Denmark highlights Europe's huge gaps.China and Russia outperformed the other three BRICS countries on all key indicators,particularly India's ARR and Brazil's AMR laboratory network and coordination capacity.Furthermore,significant internal disparities in carbapenem-resistant Klebsiella pneumoniae(CRKP)and methicillin-resistant Staphylococcus aureus(MRSA)prevalence were observed between China and the USA,with MRSA prevalence both gradually declining,whereas CRKP prevalence has been declining in the USA but increasing in China,consistent with higher carbapenems-related indicator'performance in USA.Conclusions:GOHI-AMR is the most comprehensive tool currently available for the assessment of AMR status worldwide.We discovered unique features impacting AMR in each country and offered precise recommendations to improve the capacity to tackle AMR in low-ranking countries.