世界衛生組織首次發布威脅健康的真菌清單

2022 年 10 月 25 日 / 部門新聞 / 世界衛生組織

世衛組織今天發布了一份報告，重點介紹了有史以來第一份真菌「重點病原體」清單——一份對公共健康構成最大威脅的 19 種真菌的目錄。考慮到未滿足的研究和開發 (R&D) 需求和公認的公共衛生重要性，世衛組織真菌優先病原體清單 (fungal priority pathogens list , FPPL) 是全球第一個系統地優先考慮真菌病原體的努力。世衛組織 FPPL 旨在重點關注並推動進一步的研究和政策介入，以加強全球對真菌感染和抗真菌藥物耐藥性的反應。

真菌病原體是對公共健康的主要威脅，因為它們變得越來越普遍並且對目前只有四類抗真菌藥物的治療具有抗藥性，並且臨床管道中的候選藥物很少。大多數真菌病原體缺乏快速和敏感的診斷方法，而現有的那些措施在全球範圍內無法廣泛獲得或負擔得起。

這些真菌感染的侵襲性形式通常會影響重症患者和具有明顯潛在免疫系統相關疾病的患者。侵襲性真菌感染風險最大的人群包括患有癌症、愛滋病毒/愛滋病、器官移植、慢性呼吸道疾病和原發性肺結核感染的人群。

新出現的證據顯示，由於全球暖化以及國際旅行和貿易的增加，真菌疾病的發病率和地理範圍都在全球範圍內擴大。在 COVID-19 大流行期間，住院患者報告的侵襲性真菌感染發生率顯著增加。隨著引起常見感染的真菌（如口腔念珠菌和陰道鵝口瘡）對治療的抵抗力越來越強，在普通人群中發生更具侵襲性的感染的風險也在增加。

世衛組織抗菌素耐藥性（AMR）助理秘書長哈南·巴爾基博士說：「在細菌性抗菌素耐藥性大流行的陰影下，真菌感染正在增長，並且對治療的抵抗力越來越強，成為全世界的公共衛生問題」。

儘管越來越受到關注，但真菌感染很少受到關注和資源，導致真菌疾病分佈和抗真菌耐藥模式的具品質之數據稀缺。結果，真菌疾病和抗真菌抗性的確切負擔是未知的，因此反應受到破壞。

三個優先類別

WHO FPPL 列表分為三類：關鍵、高和中等優先級。每個優先類別中的真菌病原體之所以如此排名，主要是因為它們對公共衛生的影響和/或新出現的抗真菌耐藥性風險。儘管將這些關鍵病原體視為全球公共衛生問題，但世衛組織強調必須仔細解釋和背景化 FPPL，因為某些地方性病原體可能在其各自的區域或當地情況下更受關注。

需要更多證據和優先行動領域

該報告的作者強調需要更多的證據來為應對這一日益嚴重的威脅提供信息，並更好地了解疾病和抗真菌耐藥性的負擔。該報告還強調迫切需要採取協調一致的行動來解決抗真菌藥物使用對「健康一體」( One Health) 範圍內耐藥性的影響，並呼籲擴大公平地獲得高質量診斷和治療的機會。

「我們需要更多關於真菌感染和抗真菌耐藥性的數據和證據，以告知和改善對這些重點真菌病原體的反應」，世衛組織 AMR 全球協調部主任 Haileyesus Getahun 博士說。

FPPL 報告強調了政策制定者、公共衛生專業人員和其他利益相關者的策略。報告中提出的共同策略旨在產生證據並改善對這些真菌優先病原體的反應，包括防止抗真菌藥物耐藥性的發展。建議的主要行動集中在： (1) 加強實驗室能力和監測； (2) 持續投資於研究、開發和創新； （三）加強公共衛生介入預防和控制。

Haileyesus Getahun 博士補充說：「鼓勵各國採取循序漸進的方法，首先是加強其真菌病實驗室和監測能力，並確保在全球範圍內公平獲得現有的優質治療和診斷方法」。

對抗真菌藥物的耐藥性部分是由 「健康一體」( One Health) 範圍內的抗真菌藥物使用不當造成的。 例如，在農業中濫用抗真菌劑與耐azole類抗真菌劑煙麴黴菌 (azole-resistant Aspergillus fumigatus) 感染率上升有關。 該報告還呼籲促進世衛組織與四方組織（註）和其他合作夥伴的合作，以解決抗真菌藥物使用對單一健康領域耐藥性的影響。

註：四方組織 – 聯合國糧食及農業組織 (FAO)、聯合國環境規劃署 (UNEP)、世界衛生組織 (WHO) 和世界動物衛生組織 (WOAH，前身為 OIE)

WHO releases first-ever list of health-threatening fungi

25 October 2022 / Departmental news / WHO

WHO today published a report highlighting the first-ever list of fungal “priority pathogens” – a catalogue of the 19 fungi that represent the greatest threat to public health.  The WHO fungal priority pathogens list (FPPL) is the first global effort to systematically prioritize fungal pathogens, considering the unmet research and development (R&D) needs and the perceived public health importance. The WHO FPPL aims to focus and drive further research and policy interventions to strengthen the global response to fungal infections and antifungal resistance.

Fungal pathogens are a major threat to public health as they are becoming increasingly common and resistant to treatment with only four classes of antifungal medicines currently available, and few candidates in the clinical pipeline. Most fungal pathogens lack rapid and sensitive diagnostics and those that exist are not widely available or affordable globally.

The invasive forms of these fungal infections often affect severely ill patients and those with significant underlying immune system related conditions. Populations at greatest risk of invasive fungal infections include those with cancer, HIV/AIDS, organ transplants, chronic respiratory disease, and post-primary tuberculosis infection.

Emerging evidence indicates that the incidence and geographic range of fungal diseases are both expanding worldwide due to global warming and the increase of international travel and trade. During the COVID-19 pandemic, the reported incidence of invasive fungal infections increased significantly among hospitalized patients. As the fungi that cause common infections (such as candida oral and vaginal thrush) become increasingly resistant to treatment, risks for the development of more invasive forms of infections in the general population are also growing.

“Emerging from the shadows of the bacterial antimicrobial resistance pandemic, fungal infections are growing, and are ever more resistant to treatments, becoming a public health concern worldwide” said Dr Hanan Balkhy, WHO Assistant Director-General, Antimicrobial Resistance (AMR). 

Despite the growing concern, fungal infections receive very little attention and resources, leading to a scarcity of quality data on fungal disease distribution and antifungal resistance patterns. As a result, the exact burden of fungal diseases and antifungal resistance, are unknown, and the response is therefore undermined.

Three priority categories

The WHO FPPL list is divided into three categories: critical, high and medium priority. The fungal pathogens of in each priority category are so ranked primarily due to their public health impact and/or emerging antifungal resistance risk. While recognizing these critical pathogens as of public health concern globally, WHO emphases that the FPPL must be interpreted and contextualized carefully, as some endemic pathogens could be of more concern in their respective regional or local contexts.

Need for more evidence and priority areas for action

The authors of the report stress the need for more evidence to inform the response to this growing threat and to better understand the burden – both of disease and antifungal resistance. The report also highlights the urgent need for coordinated action to address the impact of antifungal use on resistance across the One Health spectrum and calls for expanding equitable access to quality diagnostics and treatments.  

“We need more data and evidence on fungal infections and antifungal resistance to inform and improve response to these priority fungal pathogens” said Dr Haileyesus Getahun, WHO Director, AMR Global Coordination Department.

The FPPL report underscores strategies for policymakers, public health professionals and other stakeholders. The strategies proposed in the report are collectively aimed at generating evidence and improving response to these fungal priority pathogens including preventing the development of antifungal drug resistance. The primary recommended actions are focused on: (1) strengthening laboratory capacity and surveillance; (2) sustaining investments in research, development, and innovation; and (3) enhancing public health interventions for prevention and control.

“Countries are encouraged to follow a stepwise approach, starting with strengthening their fungal disease laboratory and surveillance capacities, and ensuring equitable access to existing quality therapeutics and diagnostics, globally” added Dr Haileyesus Getahun.

Resistance to antifungal medicines is partly driven by inappropriate antifungal use across the One Health spectrum. For example, injudicious use of antifungals in agriculture was linked to the rising rates of azole-resistant Aspergillus fumigatus infections. The report also calls for fostering WHO’s collaborative effort with the Quadripartite organizations and other partners, to address the impact of antifungal use on resistance across the One Health spectrum.