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Professor Lu Shuihua: Don't let down your guards in this "protracted war" against tuberculosis [Eastern Forum on Tuberculosis - Popular Science].

  • Categories:Industry Trends
  • Author:Lu Shuihua
  • Origin:Shanghai Public Health Tuberculosis Department Tuberculosis Oriental Forum
  • Time of issue:2020-11-09
  • Views:0

(Summary description)

Professor Lu Shuihua: Don't let down your guards in this "protracted war" against tuberculosis [Eastern Forum on Tuberculosis - Popular Science].

(Summary description)

  • Categories:Industry Trends
  • Author:Lu Shuihua
  • Origin:Shanghai Public Health Tuberculosis Department Tuberculosis Oriental Forum
  • Time of issue:2020-11-09
  • Views:0
Information

<Author Introduction>

Lu Shuihua, Director of Tuberculosis Department and Director of the Tuberculosis Research Center of Shanghai Public Health Clinical Center, and Vice-Chairman of the Tuberculosis Society of the Chinese Medical Association.

 

From August 21, 2019 to October 12, 2020, 22 cases with tuberculosis (TB) were found in students at Pan'an Lake Campus of Jiangsu Normal University and all of these students had been suspended from school and underwent standard anti-TB treatment for at least half a year. After intensive screening, another 43 students were found to have abnormal chest CT images, requiring further investigation.

Other tuberculosis outbreaks in domestic campuses since 2017:

In August 2017, a senior student in a high school in Taojiang County, Hunan Province, was diagnosed with tuberculosis, and more than 50 students in the class were subsequently diagnosed. By mid-November of that year, a total of 74 students in the school had been diagnosed.

 

 

On November 20, 2017, Professor Lu Shuihua and Bai Yansong discussed the Taojiang pandemic on "News 1+1".

In September 2018, a kindergarten teacher in Jiangyin, Jiangsu province, was diagnosed with tuberculosis, and 32 people were infected, including 28 children and 4 staff members, with 5 children diagnosed with tuberculosis.

In June 2019, seven children were infected with tuberculosis after a teacher at an early childhood education center in Nanjing was infected with tuberculosis.

In December 2019, a number of students in the computer science department of a vocational college in Hebei province were sent to a local hospital for treatment because of tuberculosis.

 
The entire population is generally susceptible to the tuberculosis bacillus, the causative agent of tuberculosis. After infection, low immune resistance and dense crowds may facilitate the occurrence and spread of tuberculosis. Students, especially freshmen from various regions, have changed living environments and are in close contact with each other in their collective lives. And they also suffer from increased mental stress, irregular eating and sleeping habits, which makes it easy for some students who have not been infected with the tuberculosis bacillus or who are infected but have not yet developed tuberculosis to develop tuberculosis when their immune system is too weak to withstand the "attack" of the tuberculosis bacillus.

 

The TB pandemic remains severe

 

The World Health Organization (WHO) estimated that about one-third of the world's population has been infected with Mycobacterium tuberculosis, and nearly half of the population in our country have been infected. In 1993, the WHO declared a "global emergency" for tuberculosis, calling for the world to join in the "war" against the disease. Today, although the TB pandemic is slowly declining, it still remains severe due to the increase in drug-resistant TB, the co-infection of human immunodeficiency virus and Mycobacterium tuberculosis, and the difficulty in controlling population mobility, making the fight against TB a "protracted war". With a large population, high population density and mobility, China is one of the countries with high burdens and risks of TB. According to data released by the WHO in 2020, TB is currently one of the top ten causes of death worldwide, and China is a nation with high burdens of TB in the world (accounting for 8.4% of the world, ranking the third). According to the National Center for Disease Control and Prevention, there were 770,000 new cases of TB in 2019, and 2,290 people died from TB. Among all the notifiable diseases in China, TB ranked the second both in numbers of cases and deaths. And according to WHO estimates, there were 833,000 new cases of TB in China in 2019, with a mortality rate of 2.35 per 100,000.

 

Mycobacterium tuberculosis: The whole population is susceptible
 

The pathogenic bacteria of TB is a complex of Mycobacterium tuberculosis including a variety of Mycobacteria, of which the main pathogenic bacteria of human TB is Mycobacterium tuberculosis (more than 90%). Mycobacterium tuberculosis has strong resistance to dry, cold, acid and alkaline environments. And the drug-resistant TB strains are even more "resilient", posing a major challenge to TB prevention and control today.

The whole population is generally susceptible to Mycobacterium tuberculosis, and the further development of TB is subject to the body's natural resistance to Mycobacterium tuberculosis. The majority of people who are infected with Mycobacterium tuberculosis will not develop the disease, while only a very small number of infected people may develop the same disease when their bodys' resistance is weakened. Genetic factors, impoverishment, overcrowded housing, and poor nutrition may affect the body's resistance to Mycobacterium tuberculosis. Infants, the elderly, HIV-infected patients, immunosuppressant users, patients with chronic diseases (e.g., diabetes), and people with long-term overstress and fatigue have low or impaired immune function and are susceptible to tuberculosis.

 

The "four challenges" in TB prevention and control

 

1. Hidden source of infection. The source of TB infection in the population is mainly TB patients that excrete the bacteria. The lack of awareness and attention of the general public and even some non-tuberculosis medical personnel to the onset and infectiousness of tuberculosis makes it a more insidious source of infection. For example, some patients with persistent cough and sputum for months do not seek medical advice because they think they just have a common cold; children with atypical symptoms make diagnosis difficult; some doctors are not alert to TB and may misdiagnose it as bronchitis or pneumonia, etc.

2. High infectivity. Tuberculosis is highly contagious and spreads rapidly. Droplet transmission is the most important way of transmission. Infectious TB patients who cough, spit, sneeze, laugh or speak loudly will emit droplets containing Mycobacterium tuberculosis and spread to those around them who may inhale these droplets. Besides, it takes a long time to confirm the diagnosis of TB, and those with undetected and untreated active TB can increase the infectivity of TB.

3. Severe conditions. The early symptoms of TB are mild and easily confused with other respiratory diseases, while some patients often develop advanced and serious disease when diagnosed, leading to irreversible damage to their lung tissue or lung function. Meanwhile, multi-drug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are difficult to treat and the severity of the disease is increased for their delayed healing.

4. Uncontrollable treatment compliance. It usually takes 6 to 18 months to cure tuberculosis, normally requiring the combined application of multiple drugs. After drug withdraw, patients still need to keep regular follow-up visits to monitor their prognosis. However, in the actual treatment process, many patients find it difficult to maintain regular medication and follow-up visits, resulting in prolonged treatment, recurrence of tuberculosis or the emergence of drug-resistant strains, which makes it more difficult to prevent and treat tuberculosis.

 

"Five Tips" to boost TB prevention and control

 

1. Early medical consultation when suspicious symptoms are detected. Cough and sputum lasting for more than two weeks, or hemoptysis or blood in sputum are common suspicious respiratory symptoms of tuberculosis. In addition, patients may also have systemic symptoms such as fever (commonly prolonged afternoon hot flashes), lethargy, night sweats, loss of appetite, weight loss, chest pain, and irregular menstruation in women of reproductive ages. Those who have the above symptoms should go to hospital in time.

2. Regular treatment follow-up visits after diagnosis. Patients diagnosed with tuberculosis should go to a specialized facility for tuberculosis as soon as possible for regular treatment. Patients must recognize the importance and effectiveness of standardized treatment, and actively cooperate with doctors to implement the policy of "early, combined, appropriate, regular and complete" treatment, without stopping or interrupting the medication. It is important to ensure the effect of the first treatment, and then most patients can be cured. After the cure, regular follow-up visits are required to prevent recurrence.

3. Preventive chemotherapy to reduce the risk of incidence of latent infection. Those who are infected with mycobacterium tuberculosis but have not yet developed the disease are "latent infectious patients". When their bodies' immunity weakens, the "latent" Mycobacterium tuberculosis will multiply in their bodies, leading to the development of tuberculosis. Preventive chemotherapy for latently infectious patients lowers the risk of tuberculosis by reducing Mycobacterium tuberculosis in their bodies. The most commonly used preventive chemotherapy is oral isoniazid for 6 months.

4. BCG vaccination to prevent childhood tuberculosis. BCG vaccination for newborns is currently a necessary measure to prevent childhood tuberculosis, which can greatly reduce the probability of children to develop severe tuberculosis such as miliary tuberculosis and tuberculous meningitis.

5. Enhanced resistance to prevent adult TB. Usually, healthy adults are able to resist tuberculosis. However, when their resistance is low or impaired, the risk of developing tuberculosis increases significantly. Young people today, in particular, are prone to become "easy targets" of tuberculosis because of the high pressure of study and work, irregular eating and sleeping. Improve the resistance by relieving stress, adjusting routines, enhancing nutrition, balancing work and rest, and exercising moderately, which are important measures to prevent TB in adults. In addition, we should pay attention to ventilation, personal hygiene, no spitting, covering the nose and mouth with a handkerchief or tissue when coughing or sneezing, regular washing, and less access to crowded places, which are all effective measures to prevent tuberculosis.

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