Source 丨21 Healthnews21 original work
Author 丨 Wei laughs
Editor 丨Xu Xu
Image source 丨 Figureworm
Recently, the Tuberculosis Branch of the Chinese Medical Association issued the "Expert Recommendations for Tuberculosis Patients to Vaccinate against the Novel Coronavirus" (hereinafter referred to as the "Recommendations"). The Recommendations are based on relevant WHO recommendations and relevant domestic technical guidelines to provide guidance for tuberculosis patients to be vaccinated against COVID-19.
It is understood that tuberculosis and COVID-19 are infectious diseases that mainly affect the lungs, and advanced age, diabetes, and immunodeficiency background are common prognostic adverse risk factors for both. Therefore, tuberculosis patients with 2019-nCoV infection have a higher risk of severe illness, and it is necessary to adopt active protection strategies such as vaccination for tuberculosis patients. However, tuberculosis patients may have HIV infection, rheumatic immune diseases, and the use of immunosuppressive drugs, so the type and timing of vaccination need to be carefully evaluated.
As the leader of the "Proposal", Lu Shuihua, the chairman-elect of the Tuberculosis Branch of the Chinese Medical Association and the director of the Department of Pulmonary Disease Medicine of the Third People's Hospital of Shenzhen, told the 21st Century Business Herald that the tuberculosis population is a high-risk group of new coronavirus infection and severe illness, and vaccination should be given priority, and it is recommended that except for active tuberculosis patients who are in the intensive treatment of anti-tuberculosis or other unstable chronic diseases, the rest of tuberculosis patients are vaccinated with the new crown vaccine.
COVID-19 makes it "harder" for tuberculosis patients
Tuberculosis is a chronic infectious disease that seriously endangers human health caused by mycobacterium tuberculosis (MTB) infection. There are three outcomes that can occur after infection with MTB: MTB is cleared; MTB is significantly replicated and clinical symptoms appear, clinically called active tuberculosis; MTB is controlled but not cleared and is dormant, and the body does not show clinical symptoms, that is, MTB latent infection.
In 2020, there were 9.87 million new TB cases worldwide, with a TB incidence of 1.27 per 100 000. China is one of the countries with a high burden of tuberculosis, with the second highest number of cases in the world.
The COVID-19 pandemic has had a huge impact on TB prevention and control. Global TB patient findings showed a downward trend in 2020, with patient registrations falling by 18% from 2019 to 5.8 million from 7.1 million. WHO estimates that about 4.1 million TB patients are currently undiagnosed or not formally reported to the national health authorities. That's a significant increase from 2.9 million in 2019.
In addition, WHO's just-released Global TB Report 2021 shows that TB deaths have risen for the first time in more than a decade. In 2020, the number of TB deaths among HIV-negative people globally increased from 1.21 million in 2019 to 1.28 million, and the mortality rate rose from 16/100 000 to 17/100 000, the first increase in TB deaths since 2005.
A questionnaire analysis based on the national TB surveillance system and a survey of 294 counties across the country showed that covid-19 has weakened TB detection and clinical diagnosis and treatment capacity. 27% of TB patients have delayed or interrupted follow-up visits due to transportation restrictions or fear of infection, 15% of counties have temporarily closed TB clinics, and 8% of counties have a shortage of anti-TB drugs.
With the outbreak of the new crown epidemic, the medical services and resources that originally belonged to tuberculosis gave way to the prevention and control of the new crown, resulting in insufficient basic services for tuberculosis. On the other hand, the isolation and lockdown caused by the new crown has also made it more difficult for tuberculosis patients in the past year to be found in time and treated.
Both domestic and international data indicate that the detection rate of tuberculosis patients during the COVID-19 pandemic has dropped significantly, which means that the COVID-19 pandemic has the potential to reverse recent progress in reducing the global burden of TUBERCULO.
In addition, as tuberculosis patients have a higher risk of becoming more severely ill with COVID-19 infection, the WHO recommends that TB patients adopt proactive preventive measures to respond to COVID-19, including proactive protection strategies such as timely COVID-19 vaccination, while continuing anti-TUBERCULO treatment.
How are TB patients vaccinated against COVID-19?
But there is not enough high-quality evidence-based medical evidence on whether TB patients can be vaccinated and how to get COVID-19.
In this context, the Tuberculosis Branch of the Chinese Medical Association issued the Recommendations based on the relevant recommendations of the WHO and relevant domestic technical guidelines, aiming to provide guidance for tuberculosis patients to receive COVID-19 vaccines.
The Recommendation holds that the principle of COVID-19 vaccination for tuberculosis patients is that they should be actively vaccinated at an appropriate time to actively prevent COVID-19, but vaccination of tuberculosis patients with severe illness or other complications should be evaluated by the Tuberculosis Department and relevant specialists. Specifically:
1. Patients with active tuberculosis have completed the intensive treatment of anti-tuberculosis, and can be vaccinated when the condition is stable;
2. It is recommended to vaccinate patients with latent infection of Mycobacterium tuberculosis and cured tuberculosis patients if there are no other contraindications;
3. Patients with active tuberculosis and other chronic diseases (immunodeficiency disease, chronic liver disease, chronic kidney disease, rheumatic immune disease, diabetes, tumor, etc.), it is recommended to be vaccinated after the relevant specialty treatment assessment is stable or after the corresponding specialty evaluation;
4. Patients with chronic diseases with tuberculosis and above stable diseases, if there are no other contraindications, it is recommended to be vaccinated against the new crown virus;
5. In order to reduce the risk of tuberculosis patients infected with new crown pneumonia, medical and health personnel, family members and other close contacts who diagnose and treat and care for tuberculosis patients should be vaccinated if there are no contraindications.
The contraindications for tuberculosis patients to receive the new crown vaccine are the same as those in China's "Technical Guidelines for New Coronavirus Vaccination (First Edition)", as follows: First, those who are allergic to the active ingredient of the vaccine, any inactive ingredient, the substance used in the production process, or those who have been allergic when they have previously received the same vaccine. Second, those who have had severe allergic reactions to vaccines in the past, such as acute allergic reactions, angioedema, and dyspnea. Third, people with uncontrolled epilepsy and other serious neurological diseases, such as transverse myelitis, Guillain-Barré syndrome, demyelinating disease, etc. Fourth, severe tuberculosis patients with symptoms such as hemoptysis, high fever, respiratory failure, and delirium. Fifth, those who are feverish, those with acute diseases, those who are in the acute onset of chronic diseases, and patients with uncontrolled serious chronic diseases. Sixth, pregnant women.
At present, many places in China have released the new crown vaccine for children aged 3-11 years old, and the indications and contraindications for childhood tuberculosis patients are the same as those for adults.
In terms of the selection of the type of new crown vaccine, the Article of the Chinese Journal of Infectious Diseases pointed out that according to the safety characteristics of the same type of vaccine in the past, the current data of tuberculosis patients receiving inactivated vaccines in China is the most sufficient, and vaccination can be given priority. The safety data of foreign mRNA vaccines are also relatively sufficient, and the safety and efficacy data of vaccines such as recombinant subunit vaccines and adenovirus vector vaccines are also gradually accumulating, and vaccination can be considered when conditions are ripe.
In addition, Lu Shuihua also pointed out that personal protective measures including wearing masks, paying attention to hand hygiene and maintaining social distancing are still needed after vaccination, and proto-TB treatment regimens and regular evaluations should continue to be maintained after vaccination.