[Global Network Reporter Li Qingyun] Tuberculosis is an ancient infectious disease, and today it is still the number one killer of infectious diseases in the world.
According to the latest "Global Tuberculosis Report 2023" released by the World Health Organization, an estimated 10.6 million people worldwide will be suffering from tuberculosis in 2022, and 1.3 million people will die from tuberculosis-related diseases.
Ending the TB epidemic requires continued action!
In recent years, my country has successively formulated documents such as the "Thirteenth Five-Year Plan for National Tuberculosis Prevention and Control Plan", the "Action Plan to Contain Tuberculosis (2019-2022)", and the "Notice on Further Strengthening the Prevention and Control of Drug-Resistant Tuberculosis" for tuberculosis prevention and control.
China's tuberculosis prevention and control has achieved remarkable results: the cure rate of tuberculosis patients has remained above 90%, and the incidence and mortality of tuberculosis have decreased in the past 20 years. However, due to my country's large population and unbalanced social development, the burden of tuberculosis is still serious .
What is the focus of tuberculosis prevention and control?
What are the specific measures to prevent and control tuberculosis in my country?
How effective are the new methods and means?
On January 23, the "Global Health Talk" live program of Huanqiu.com invited Xu Caihong, director of the Comprehensive Business Department of the Tuberculosis Prevention and Control Center of the Chinese Center for Disease Control and Prevention, and Chen Bin, director of the Tuberculosis Prevention and Control Institute of the Zhejiang Provincial Center for Disease Control and Prevention, to participate in "We End the Tuberculosis Epidemic" Live broadcast with the theme of "In Action" shares the specific practices of tuberculosis prevention and control in my country with netizens.
Eliminating tuberculosis requires controlling latent tuberculosis infection
Preventive treatment of persons latently infected with Mycobacterium tuberculosis is one of the key measures in the strategy to end the tuberculosis epidemic.
So, what is latent tuberculosis infection?
Xu Caihong explained that latent tuberculosis infection means that the body is infected with Mycobacterium tuberculosis, but there are no symptoms and signs of clinical tuberculosis, and there is no evidence of active tuberculosis in bacteriology and imaging.
"After human beings are infected with Mycobacterium tuberculosis, about 5% of infected people will develop active tuberculosis in a short period of time, and about 95% of infected people will have Mycobacterium tuberculosis enter a long-term "latent" state, that is, latent tuberculosis infection. This group of people is about 5%-10% will develop active TB during their lifetime. Most occur within 5 years of initial infection."
How to find out who is latent infected?
Chen Bin said that currently commonly used diagnostic methods for latent tuberculosis infection include gamma interferon release test (IGRA), tuberculin skin test (TST) and recombinant Mycobacterium tuberculosis fusion protein skin test (EC).
IGRA has better sensitivity and specificity, but the detection cost and experimental requirements are relatively high. As a skin test, TST is widely used in detection in aggregated groups, but due to antigen cross-reaction, the specificity is easily affected, and there will be Certain false positives.
As a new skin test, EC is not affected by BCG and non-tuberculous mycobacteria, and has good sensitivity and specificity.
"It mainly depends on the comprehensive consideration of screening accuracy requirements and cost in various places to comprehensively select the above three methods to detect latent tuberculosis infection." Chen Bin said.
As the author of the 2023 new version of the "China Tuberculosis Preventive Treatment Guidelines", Xu Caihong pointed out that people with latent tuberculosis infection are the potential tuberculosis "patient pool". How to avoid or reduce the intervention measures taken to prevent infected people from progressing to active tuberculosis, we call it It's called "tuberculosis preventive treatment."
Why is preventive treatment of people with latent tuberculosis infection so important?
Xu Caihong said that on the one hand, although people with latent tuberculosis infection have no symptoms and signs of tuberculosis and are usually not contagious, they are at risk of progressing to active tuberculosis.
On the other hand, preventive treatment for people with latent tuberculosis infection can achieve very good protective effects. Studies have shown that the protection rate of preventive treatment can reach 60%-90%, which can reduce the occurrence of sources of infection from the source and is a rapid way to reduce the risk of infection. tuberculosis incidence and one of the key interventions to end the tuberculosis epidemic.
The 2023 version of the "China Tuberculosis Preventive Treatment Guidelines" proposes 5 commonly used drugs for preventive treatment of patients with latent tuberculosis infection.
Xu Caihong said that the five commonly used anti-tuberculosis drugs include isoniazid, rifampicin, rifapentine, levofloxacin and Mycobacterium vaccae for injection.
The first four drugs are mainly used to form chemopreventive treatment regimens, and the last one, Mycobacterium vaccae for injection, is an immune preventive treatment.
“Compared with chemopreventive regimens, the course of treatment is shorter, has good safety, is non-hepatotoxic, will not lead to drug resistance, and will not adversely affect the treatment of underlying diseases, so the compliance of infected patients will be better. .”
Disease control experts share the “China path” for tuberculosis prevention and control
In order to achieve the goal of ending the tuberculosis epidemic, my country has embarked on a "Chinese path" in tuberculosis prevention and control.
In 2022, the Chinese Center for Disease Control and Prevention announced the "Action Plan for Creating Tuberculosis-Free Communities" and selected 36 communities nationwide for pilot projects.
"The so-called tuberculosis-free community refers to a community where the incidence of tuberculosis among the permanent population is less than 10/100,000." Xu Caihong said that through the exploration of tuberculosis-free communities/counties, we can further strengthen tuberculosis diagnosis, prevention, treatment, management, etc. The promotion and application of new technologies in all aspects, starting from the establishment of TB-free community demonstration sites at the community level, will explore the path to end the tuberculosis epidemic in my country from point to line and area.
It is reported that Zhejiang Province has taken the lead in the country in proposing the goal of full provincial coverage of tuberculosis-free community construction. Currently, it has launched the construction of 2 national sites and 19 provincial sites, covering all prefectures and cities.
Chen Bin introduced that among the tuberculosis prevention and control measures in Zhejiang Province, active screening and preventive treatment are highlighted, and health education on screening and preventive treatment is focused.
“For example, we will use new media, lectures, going to campuses, going into the community, etc. to promote tuberculosis preventive treatment to increase public awareness of preventive treatment.”
“In fact, some areas such as Ningbo, Huzhou and other places have launched the construction of preventive treatment consultation clinics. According to local conditions, some places have set up clinics at the community outpatient level, and some have set them up at district and county disease control or county designated hospitals. level, have carried out preventive treatment for high-risk groups, and comprehensively applied drug prevention and immunoprophylaxis to prevent the occurrence of active tuberculosis." Chen Bin said that our grassroots level is exploring a path to implement immunopreventive treatment.
Some areas are exploring unified procurement of Mycobacterium vaccae for injection at the county level, and then providing it to grassroots communities for injection.
If conditions permit, drug preventive treatment can also be further extended to the grassroots level in the future.
"By actively promoting new diagnostic technologies, new treatment options and new management tools, we are confident that we can achieve the goal of ending tuberculosis as scheduled." Chen Bin called on everyone to work together to move the barrier of tuberculosis prevention and control forward and carry out active screening and Preventive treatment allows early detection and treatment of latent tuberculosis infections, which can not only alleviate individual suffering, but also contribute to the accelerated decline in the incidence of tuberculosis nationwide.