TB prevention and control back 5 to 8 years: be careful of the “white plague” comeback.

During the outbreak of neo-crown pneumonia, due to fear of infection, tuberculosis patient Li Xing (analytic) has been afraid to go to the hospital to review, originally need to check the blood routine, sputum smears and liver and kidney function, etc. because of the outbreak was disrupted. She described the time as “in a dark tunnel, I don’t know how long it will take to see the light.” There are many TB patients who have suffered similar problems with Li Xing, and when the world’s attention is focused on the new crown pneumonia, TB, the world’s deadly infectious disease, has to make way for it.

Author: Li Huixuan Zhang Siwei.

Studies have shown that large numbers of TB patients are unable to be diagnosed and treated, or will die from 1.4 million TB patients, as countries focus on the new corona pneumonia.

How to stop tuberculosis, known as the “white plague”, from making a comeback in the new crown pneumonia epidemic has become an urgent problem to be solved in the whole public health field.

The doctor reviews the chest tablets of TB patients. Photo from the Center for Social Media Research at Peking University.

TB prevention and control back 5 to 8 years.

Recently, at a seminar on “TB Prevention and Control and Public Health Construction in the New Crown Epidemic” organized by the Center for Social Media Research at Peking University, Madhukar Pai, Director of the McGill International Tuberculosis Center in Montreal, Canada, threw out a worrying set of figures that could lead to 6.3 million new TB patients by 2025 and 1.4 million new TB deaths by 2025.

According to Huang Fei, a researcher at the China Center for Disease Control and Prevention, the number of first-time TB patients( including suspected cases) remained stable at 700,000 to 800,000 in each quarter from 2017 to 2019.

However, in the first quarter of 2020, this figure decreased significantly, by 260,000 compared to the fourth quarter of 2019.

“This means that some people have suspicious symptoms, such as coughing, sputum, fever, etc. In addition to outpatient visits, patient follow-up rate, drug-resistant patient screening rate and other indicators have decreased. “

In the short term, traffic control, patient anxiety and the suspension of TB clinics in health facilities will have a negative impact on the detection, treatment and management of TB patients, Huang said.

Pai said that not only in China, but also during the outbreak, many countries, especially those with high TB burdens, experienced problems such as shrinking medical structures, delays in patient access, and declining priority for TB testing, which led directly to a sharp drop in patient detection rates and, at its worst, an 80 percent reduction in TB cases reported in India.

And it is not only medical institutions that have made way, in order to prevent and control the outbreak of new crown pneumonia, countries may invest funds and manpower for the prevention and control of TB to the new crown.

“TB control at all levels will be affected as resources are diverted to the new coronary pneumonia prevention and the epidemic climbs.” Kirtan Deda, a tuberculosis expert at the University of Cape Town in South Africa, admits.

In addition, research published jointly by Imperial College, Avenir Health, Johns Hopkins University and the International Development Agency shows that global TB incidence and deaths will rise to 2013-2016 levels in 2021, suggesting that the fight against TB has gone back at least five to eight years as a result of the outbreak.

will be at great risk.

“The most vulnerable groups in society bear the brunt of the new crown pneumonia outbreak, which also bears the risk from tuberculosis, malaria and AIDS.”

Sumia Swaminathan, chief scientist at the World Health Organization, said that even as governments focused on the new crown pneumonia outbreak, she was concerned that the rapid increase in the three infections could lead to more deaths.

“When we focus almost entirely on neo-crown pneumonia, the deadly infectious diseases that could have been treated are ignored.”

Ms. Bargavilao, an infectious disease doctor with Ms. No Borders, believes that the world is at great risk of undoing 20 years of progress in the fight against AIDS, tuberculosis and malaria.

This neglect is reflected in the priority given by manufacturers to the development and production of products needed for new coronavirus testing and treatment, as well as in the cancellation of health system service access reduction and infectious disease prevention projects.

New crown pneumonia and tuberculosis are respiratory diseases, in the diagnosis and treatment of certain similarities.

After the outbreak of neo-crown pneumonia, drug shortages and rising prices are common difficulties faced by many TB patients.

Patient Chen Xinlei (ad.) has been taking Generic TB drugs in India before, the new crown outbreak began after the shortage of Drugs in India, the price has multiplied, he and many patients to buy drugs rising costs, or even therefore cut off the drug.

In addition, some anti-tuberculosis drugs have been combined with new crown drugs for treatment, resulting in a shortage of medicines.

It is highly likely that the drug will cause drug resistance in TB patients, or from drug-resistant TB to multidrring TB. What is even more worrying is that drug-resistant TB has a longer treatment cycle and a heavier burden of disease than regular TB, which costs about 200,000 to 300,000 yuan, or more, according to the World Health Organization’s latest recommended treatment.

In the worst-case scenario, TB deaths in China, India and South Africa will increase by 23,000, 150,000 and 29,000, respectively, in the worst-case scenario,’ according to a study shared by Pai on the potential impact of the new crown outbreak on the burden of TB disease.

There is a long way to go in the fight against tuberculosis.

At present, the human fight against the new coronavirus is not over. How to prevent and control the new crown at the same time take into account the prevention and control of other infectious diseases, to avoid the next global public health event? Pai believes that ensuring continuity of TB prevention and treatment services during the new crown outbreak is a top priority.

In particular, patient diagnosis and reporting should be resumed as soon as possible, and TB should be detected using a multi-disease detection platform.

“Both TB and neo-crown pneumonia have clinical symptoms of fever and cough, so public and private medical institutions can be encouraged to use this common simultaneous screening of both conditions to restore TB screening and diagnostic services.”

He stressed that TB projects must continue to use Xpert MTB/RIF testing technology, which in many cases is critical for early detection of drug-resistant TB.

In terms of treatment, in some remote areas, Pai recommends starting teletherapy support to help patients get more frequent medical consultations while reducing the number of visits to medical facilities for face-to-face treatment.

In addition, it is important to ensure drug access, and the use of WHO-recommended full-oral, short-range TB treatment options is critical because second-line anti-TB injections are not available during the outbreak.

Global production of anti-tuberculosis drugs must also be guaranteed to avoid large-scale drug shortages.

Therefore, after the prevention and control of the new crown epidemic gradually normalized, remodeling the treatment mode of tuberculosis may reduce the impact of the new crown epidemic on tuberculosis.

Pai believes that as health care rapidly shifts to an online, electronic healthcare model, it is necessary to leverage multiple treatment technologies and digital connectivity solutions.

The combination of the two can achieve the “patient-centered” integrated diagnosis and treatment model.

As for how to prevent and control tuberculosis in the next step, Huang Fei suggested that we can take advantage of a new round of public health construction to strengthen laboratory testing, drug supply and human resources, and improve the tuberculosis prevention and control service system.

In addition, international and domestic exchanges and cooperation can be actively carried out to promote research and development of laboratory diagnostic technologies, vaccines, drugs and management tools, and to raise the scientific level of tuberculosis prevention and treatment.

At the same time, Huang Fei called on the media to improve public awareness of tuberculosis prevention and control through various forms of publicity activities, and further create a good social environment for universal participation and group control.