Correspondence
[email protected] Trauma Research Center, Baqiyatallah University of Medial Sciences, Tehran, Iran (HRR, AE, MHKM); and Molla Sadra Street, PO Box 1436614313, Tehran, Iran (AE) 1
2
3
4
5
Hardwicke J, Hunter T, Staruch R, Moiemen N. Chemical burns—an historical comparison and review of the literature. Burns 2012; 38: 383–87. Olaitan PB, Jiburum BC. Chemical injuries from assaults: an increasing trend in a developing country. Indian J Plast Surg 2008; 41: 20–23. Farhad H, Naghibzadeh B, Nouhi AH, Rad HE. Acid burn violence in Iran. Ann Burns Fire Disasters 2011; 24: 138–40. Mannan A, Ghani S, Clarke A, Butler PE. Cases of chemical assault worldwide: a literature review. Burns 2007; 33: 149–54. Maghsoudi H, Gabraely N. Epidemiology and outcome of 121 cases of chemical burn in East Azarbaijan province, Iran. Injury 2008; 39: 1042–46.
Prevalence of tuberculosis in China The findings of the study by Lixia Wang and colleagues (June 14, p 2057)1 about tuberculosis prevalence should be interpreted with caution. The 2010 survey was smaller than previous surveys and diagnosed only 188 smear-positive cases from 176 sites. 2,3 The strategy of the 2000 survey3 was to select individuals in proportion to population size, whereas an even split between rural and urban participants was prioritised in 2010. The present analyses 1 were not standardised for age or urbanisation. Differences also existed in residency requirements, duration of cough (symptom screen), and number of sputa cultured. The diagnostic algorithms differed between the surveys, making comparisons difficult. The authors claim that the absence of a decrease in overall pulmonary tuberculosis is explained by greater sensitivity of radiography compared with fluoroscopy. The 2000 survey provides an opportunity to address this claim. Excluding radiographs from the algorithm, the prevalence dropped by less than 6%.3 A much greater www.thelancet.com Vol 385 February 28, 2015
difference is needed to explain the 2010 results (>35%). A substantial decrease in the prevalence of known, but not new, laboratory-confirmed tuberculosis cases was reported. 1 The decrease in known tuberculosis cases suggests improved clinical care, whereas no decrease in new cases suggests insufficient measures to prevent Mycobacterium tuberculosis transmission. Together, these results imply a case detection problem. In this study, sputum quality 4 might have affected the results. We note that 54% of culture-positive cases were sputum-smear positive compared with more than 70% in the past surveys.2,3 Tuberculosis indicators can decrease in the absence of chemotherapy.5 The estimated annual decrease in tuberculosis prevalence in China during 1990–2010 was similar to the 1979–90 period.1,3 With ongoing human development, which inversely associates with tuberculosis indicators,6 cohort effects should be considered, and an accelerated decrease in tuberculosis prevalence is needed to indicate effectiveness of directly observed therapy short-course. We declare no competing interests.
*Philip C Hill, Christopher C Whalen [email protected] Centre for International Health and the Otago International Health Research Network, Department of Preventive and Social Medicine, University of Otago School of Medicine, Dunedin 9054, New Zealand (PCH); and Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Health Sciences Campus, Athens, GA 30602, USA (CCW) 1
2
3
4
Wang L, Zhang H, Ruan Y, et al. Tuberculosis prevalence in China, 1990–2010; a longitudinal analysis of national survey data. Lancet 2014; 383: 2057–64. Ministry of Public Health. Nationwide random survey of the epidemiology of tuberculosis in 1990. Beijing: Ministry of Public Health China, 1990. China Tuberculosis Control Collaboration. The effect of tuberculosis control in China. Lancet 2004; 364: 417–22. Sakundarno M, Nurjazuli N, Jati SP, et al. Insufficient quality of sputum submitted for tuberculosis diagnosis and associated factors, in Klaten district, Indonesia. BMC Pulm Med 2009; 9: 16.
5
6
McKeown T, Record RG. Reasons for the decline of mortality in England and Wales during the Nineteenth Century. Popul Stud 1962; 16: 94–122. Dye C, Lonnroth K, Jaramillo E, Williams BG, Raviglione M. Trends in tuberculosis incidence and their determinants in 134 countries. Bull World Health Organ 2009; 87: 683–91.
Antibiotic pollution threatens public health in China In December, 2014, antibiotics were detected in residents’ tap water and China’s major rivers.1 Antibiotic pollution has become a serious public health problem in China.2,3 Two antibiotics (amoxicillin [8 ng/L] and 6-aminopenicilanic acid [19 ng/L]) were found in tap water samples randomly collected in Nanjing, Jiangsu Province. Six antibiotics were also found in tap water in cities of Anhui Province.1 Antibiotics were found in major rivers, including the Yangtze River and Pearl River. 68 antibiotics, at high concentrations, were found in surface water.2 While antibiotic concentrations found in the Pearl River were as high as 1080 ng/L,2 these are usually lower than 20 ng/L in rivers in the USA,4 France, and the UK.5 Antibiotic pollution poses a grave risk to millions of residents and to local ecosystems.6 The concentrations of antibiotics in the surface water are far smaller than those of medical doses, but these antibiotics can induce bacterial resistance in human beings, rendering many drugs ineffective and damaging ecological systems. Additionally, long-term antibiotics pollution will contaminate groundwater and soil, which could result in contamination of food.2 Antibiotic pollution in China is linked to two main issues: the misuse of antibiotics in the medical and livestock industries,1,2 and effluent containing high concentrations of antibiotics being discharged by pharmaceutical companies. Antibiotic comsumption is ten times the global
Chen Jin/Redlink/Corbis
Hamid Reza Rasouli, *Ali Ebrahimi, Mohammad Hosein Kalantar Motamedi
773
[email protected] Trauma Research Center, Baqiyatallah University of Medial Sciences, Tehran, Iran (HRR, AE, MHKM); and Molla Sadra Street, PO Box 1436614313, Tehran, Iran (AE) 1
2
3
4
5
Hardwicke J, Hunter T, Staruch R, Moiemen N. Chemical burns—an historical comparison and review of the literature. Burns 2012; 38: 383–87. Olaitan PB, Jiburum BC. Chemical injuries from assaults: an increasing trend in a developing country. Indian J Plast Surg 2008; 41: 20–23. Farhad H, Naghibzadeh B, Nouhi AH, Rad HE. Acid burn violence in Iran. Ann Burns Fire Disasters 2011; 24: 138–40. Mannan A, Ghani S, Clarke A, Butler PE. Cases of chemical assault worldwide: a literature review. Burns 2007; 33: 149–54. Maghsoudi H, Gabraely N. Epidemiology and outcome of 121 cases of chemical burn in East Azarbaijan province, Iran. Injury 2008; 39: 1042–46.
Prevalence of tuberculosis in China The findings of the study by Lixia Wang and colleagues (June 14, p 2057)1 about tuberculosis prevalence should be interpreted with caution. The 2010 survey was smaller than previous surveys and diagnosed only 188 smear-positive cases from 176 sites. 2,3 The strategy of the 2000 survey3 was to select individuals in proportion to population size, whereas an even split between rural and urban participants was prioritised in 2010. The present analyses 1 were not standardised for age or urbanisation. Differences also existed in residency requirements, duration of cough (symptom screen), and number of sputa cultured. The diagnostic algorithms differed between the surveys, making comparisons difficult. The authors claim that the absence of a decrease in overall pulmonary tuberculosis is explained by greater sensitivity of radiography compared with fluoroscopy. The 2000 survey provides an opportunity to address this claim. Excluding radiographs from the algorithm, the prevalence dropped by less than 6%.3 A much greater www.thelancet.com Vol 385 February 28, 2015
difference is needed to explain the 2010 results (>35%). A substantial decrease in the prevalence of known, but not new, laboratory-confirmed tuberculosis cases was reported. 1 The decrease in known tuberculosis cases suggests improved clinical care, whereas no decrease in new cases suggests insufficient measures to prevent Mycobacterium tuberculosis transmission. Together, these results imply a case detection problem. In this study, sputum quality 4 might have affected the results. We note that 54% of culture-positive cases were sputum-smear positive compared with more than 70% in the past surveys.2,3 Tuberculosis indicators can decrease in the absence of chemotherapy.5 The estimated annual decrease in tuberculosis prevalence in China during 1990–2010 was similar to the 1979–90 period.1,3 With ongoing human development, which inversely associates with tuberculosis indicators,6 cohort effects should be considered, and an accelerated decrease in tuberculosis prevalence is needed to indicate effectiveness of directly observed therapy short-course. We declare no competing interests.
*Philip C Hill, Christopher C Whalen [email protected] Centre for International Health and the Otago International Health Research Network, Department of Preventive and Social Medicine, University of Otago School of Medicine, Dunedin 9054, New Zealand (PCH); and Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Health Sciences Campus, Athens, GA 30602, USA (CCW) 1
2
3
4
Wang L, Zhang H, Ruan Y, et al. Tuberculosis prevalence in China, 1990–2010; a longitudinal analysis of national survey data. Lancet 2014; 383: 2057–64. Ministry of Public Health. Nationwide random survey of the epidemiology of tuberculosis in 1990. Beijing: Ministry of Public Health China, 1990. China Tuberculosis Control Collaboration. The effect of tuberculosis control in China. Lancet 2004; 364: 417–22. Sakundarno M, Nurjazuli N, Jati SP, et al. Insufficient quality of sputum submitted for tuberculosis diagnosis and associated factors, in Klaten district, Indonesia. BMC Pulm Med 2009; 9: 16.
5
6
McKeown T, Record RG. Reasons for the decline of mortality in England and Wales during the Nineteenth Century. Popul Stud 1962; 16: 94–122. Dye C, Lonnroth K, Jaramillo E, Williams BG, Raviglione M. Trends in tuberculosis incidence and their determinants in 134 countries. Bull World Health Organ 2009; 87: 683–91.
Antibiotic pollution threatens public health in China In December, 2014, antibiotics were detected in residents’ tap water and China’s major rivers.1 Antibiotic pollution has become a serious public health problem in China.2,3 Two antibiotics (amoxicillin [8 ng/L] and 6-aminopenicilanic acid [19 ng/L]) were found in tap water samples randomly collected in Nanjing, Jiangsu Province. Six antibiotics were also found in tap water in cities of Anhui Province.1 Antibiotics were found in major rivers, including the Yangtze River and Pearl River. 68 antibiotics, at high concentrations, were found in surface water.2 While antibiotic concentrations found in the Pearl River were as high as 1080 ng/L,2 these are usually lower than 20 ng/L in rivers in the USA,4 France, and the UK.5 Antibiotic pollution poses a grave risk to millions of residents and to local ecosystems.6 The concentrations of antibiotics in the surface water are far smaller than those of medical doses, but these antibiotics can induce bacterial resistance in human beings, rendering many drugs ineffective and damaging ecological systems. Additionally, long-term antibiotics pollution will contaminate groundwater and soil, which could result in contamination of food.2 Antibiotic pollution in China is linked to two main issues: the misuse of antibiotics in the medical and livestock industries,1,2 and effluent containing high concentrations of antibiotics being discharged by pharmaceutical companies. Antibiotic comsumption is ten times the global
Chen Jin/Redlink/Corbis
Hamid Reza Rasouli, *Ali Ebrahimi, Mohammad Hosein Kalantar Motamedi
773
