In the past two years, China has used "dynamic clearing" of screening and isolation policies to eradicate the root causes, and has achieved victory in the prevention and control of the new crown epidemic in every local area.
This prevention and control experience also provides a reference for the prevention and control of other infectious diseases, especially tuberculosis.
"The Law on the Prevention and Control of Infectious Diseases is being revised and is currently in the stage of soliciting opinions. It requires that pulmonary tuberculosis patients in the infectious period should be isolated at home or hospitalized, and their close contacts should be screened as necessary. If infectious disease patients can be isolated By treating and managing the source of infection, China's tuberculosis prevention and control effect will be effective soon." Gao Lei, a researcher at the Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, said in an interview with Yicai.com.
Regarding tuberculosis, the oldest infectious disease, although China has taken many prevention and control measures, and the control of the incidence of tuberculosis has achieved remarkable results, there are still challenges to the goal of ending this infectious disease.
How can we "remove the root cause" of tuberculosis?
Transmission is not interrupted - 20% of tuberculosis flows across regions
Interrupting the spread of the source of infection is the main way to end an infectious disease in a region.
But for tuberculosis, the infection has not been interrupted, and tuberculosis still poses a serious threat to global public health.
According to the "Global Tuberculosis Report 2021" released by the World Health Organization, it is estimated that in 2020, there will be 9.87 million new cases of tuberculosis and 1.5 million deaths from tuberculosis.
Among them, the number of new cases of tuberculosis in China is 842,000, ranking second in the world after India, with more than 30,000 deaths due to tuberculosis.
"More than 60% of new tuberculosis patients are in rural areas each year, more than 70% of them are in the labor force, and more than 20% of patients move across regions. Although we have been preventing and controlling, the measures to block the spread of the source of infection are insufficient. As a result, the transmission has always existed. Moreover, compared with the past, there has been an increase of MDR-TB, and even primary MDR-TB and transmission, and the difficulty of prevention and control of pulmonary tuberculosis and the cost of the disease have further increased.” A tuberculosis prevention and control field experts said.
Chen Jiayin, director of the Department of Humanities and Management, Kangda College, Nanjing Medical University, and director of the Center for Health Policy Research, Nanjing Medical University, believes that the current outstanding status of tuberculosis is that the incidence rate remains high, although the United Nations and the World Health Organization have proposed the goal of ending the epidemic of tuberculosis. , but the effect is not high. China is also one of the 22 countries with a heavy burden of tuberculosis. It has ranked first for many years. Now it ranks backward, but the burden is still heavy.
For MDR-TB patients and ordinary TB patients, the family economic burden is also relatively heavy, especially for MDR-TB patients.
Chen Jiayin said that tuberculosis is characterized by effective and curable treatment.
At present, some free treatment measures taken by the state, including free medicines, free examinations, free sputum examinations, and free chest X-rays, are worthy of recognition.
"The 'three-in-one' of prevention, treatment and management in designated hospitals, the responsibility for treatment is carried out in each hospital, and there is no big problem. However, how to reduce transmission and how to take the initiative to manage others needs to be further implemented. Strength." Chen Jiayin said.
For many years, the management of tuberculosis patients and close contacts in my country has been in a loose state.
At present, my country not only does not have mandatory isolation treatment and travel restrictions for pulmonary tuberculosis patients in the infectious period, but also lacks prevention and control measures for the screening of tuberculosis close contacts and asymptomatic TB carriers in the incubation period.
But for respiratory infectious diseases, they are all important sources of infection.
"For confirmed tuberculosis patients, it is not isolated treatment, but home treatment. There are no strict legal requirements for travel, and many tuberculosis patients are not restricted to take public transportation, including planes. Secondly, for the management of close contact, due to the cost The main problem is symptom screening, that is, only those who have symptoms will be tested for tuberculosis. However, there is a large error in judging based on symptoms, because many people are closely infected with tuberculosis and have no symptoms for a long time. Once symptoms are found , it has already begun to spread." The above-mentioned expert said.
Judging from the "treatment and management of pulmonary tuberculosis patients" stipulated in the "Technical Specifications for Tuberculosis Prevention and Control in China", China's family management model for active pulmonary tuberculosis patients included in treatment uses the means of "supervision", including supervising taking medicines, supervising regular Re-examination, etc.
"This method of urging does not allow TB patients to take their medicines in place, which is one of the reasons for the increasing number of multi-drug-resistant TB in China. For an infectious disease that can be cured with drugs, these identified sources of infection cannot be managed properly if they are not managed properly. , the lack of treatment will bring about the continued transmission and the emergence of multidrug-resistant tuberculosis. We now have both." The above-mentioned expert said.
In addition, "for the new coronary pneumonia, the infected person is found through nucleic acid testing, strict isolation and treatment, close and sub-close contact, isolation and continuous nucleic acid testing at the same time, until the isolation period expires." Gao Lei Said that if this way, the incidence of tuberculosis will plummet.
The state of loose management of tuberculosis patients and close contacts is expected to change.
The revised draft of the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases is soliciting comments.
Among them, Article 45 stipulates that "patients with positive pulmonary tuberculosis should be treated with standardized isolation and drug resistance during the infectious period, and their close contacts should be screened. Carry out diagnosis and treatment of multidrug-resistant tuberculosis. The institutions must have corresponding isolation and infection control conditions. Tuberculosis patients should take necessary protective measures such as wearing masks according to the needs of prevention and control to avoid spreading to others. Tuberculosis patients must hold a certificate issued by a designated medical institution before returning to work and school. ."
Passively detected pulmonary tuberculosis - 20 days delay in diagnosis
Tuberculosis is mainly transmitted through the respiratory tract. If the detection and treatment are not timely, and the management is not in place, it can lead to further transmission.
"Patients of tuberculosis in China are mainly found passively, and there are few measures for active discovery. Passive discovery is often in comprehensive medical institutions, and nearly 93% of patients go to comprehensive medical institutions for the first diagnosis. Due to the special treatment system for tuberculosis The existence of TB causes many comprehensive medical institutions not to be responsible for the diagnosis and treatment of tuberculosis. Doctors do not think about tuberculosis. After all, it is an inflammatory reaction. The first thing doctors will think about is pneumonia caused by viruses and bacteria. This passive discovery It will lead to delay in diagnosis and spread." Gao Lei believes.
How to actively detect has always attracted the attention of the field of tuberculosis, and my country has also put forward relevant requirements for active detection.
The "Thirteenth Five-Year" National Tuberculosis Prevention and Control Plan requires active screening of close contacts of pulmonary tuberculosis patients with positive etiological examination, HIV-infected patients and patients, elderly people over 65 years old, and diabetic patients. Work.
Strengthen the active screening of tuberculosis among people leaving the country, and take appropriate medical and prevention and control measures.
Incorporate tuberculosis screening into school admissions, supervision places (prisons, detention centers, detention centers, detention and education centers, compulsory isolation drug rehabilitation centers, compulsory medical centers, etc.) and the health examination items for people entering prisons (institutions) and floating population, and early detection Source of infection.
Counties, townships and villages with a high incidence of epidemics should carry out a census of tuberculosis.
"But in fact, in key groups such as the elderly with high incidence of tuberculosis, people with diabetes, floating population and miners, as well as in key places such as labor-intensive factories and mines, long-term care institutions, supervision sites and large-scale farms, active tuberculosis screening work has not been carried out. Fully or not yet systematically carried out." The above-mentioned experts said.
According to the results of a recent multicenter study on delayed tuberculosis diagnosis, the median delay in diagnosis of etiologically positive pulmonary tuberculosis patients was 20 days. Diagnosed on first visit.
In terms of drug-resistant tuberculosis prevention and control, by 2020, 17% of new etiological-positive tuberculosis patients in the country will still not receive drug resistance screening.
"We have faster and more accurate diagnostic technology, and the cost of diagnosis is not high. It is possible to do a large-scale screening and fish out infected people. Whether it is treatment or preventive medicine during the incubation period, there are shorter-term prevention and treatment options. Treatment plan. However, we must take the first step and find people who have been infected with tuberculosis before we can carry out precise intervention, which is extremely important for the prevention of infectious diseases.” Gao Lei believes.
From the perspective of the practice of new coronary pneumonia prevention and control, it is difficult to effectively control the epidemic of tuberculosis by relying solely on the disease control system and hospitals to block the epidemic of an infectious disease.
"Similar to the new crown pneumonia, comprehensive measures are also required in the prevention and control of tuberculosis. The CDC mainly carries out coordination and information support, timely reporting and other related organizational coordination; medical institutions mainly focus on detection, diagnosis, treatment, and management; medical insurance can Guide and encourage medical institutions to take the initiative to discover patients and take the initiative to manage patients." Gao Lei said.
The "14th Five-Year Plan" is a critical period for my country's tuberculosis prevention and control. In order to achieve the staged prevention and control goal of the strategy to end the tuberculosis epidemic in 2025, China urgently needs to give full play to the "uniform leadership of the government, departments responsible for their respective responsibilities, and extensive participation of the whole society". The role of TB control mechanisms and proactive action to accelerate progress in TB control.
"Whether the goal of ending the TB epidemic can be achieved depends on whether the government can work closely with all stakeholders and effectively exercise leadership and departmental responsibilities. In my country, multi-sectoral cooperation has been widely used in the prevention and control of AIDS and COVID-19. According to the needs of tuberculosis prevention and control, combined with the responsibilities of relevant departments, it is extremely necessary to use the existing successful experience for tuberculosis prevention and control.” Gao Lei believes.
Gao Lei suggested that China should comprehensively implement patient-centered comprehensive prevention and control measures as soon as possible, actively detect and diagnose tuberculosis at an early stage (carry out drug susceptibility tests, systematically screen contacts and high-risk groups, etc.) All TB patients are treated and cared for, and preventive treatment is provided for high-risk groups. The role of the government and related departments in TB prevention and control is fully leveraged, and TB prevention and control are integrated into all policies to accelerate the rate of decline in TB incidence.
Article author
Ma Xiaohua